HLTAID004 Provide an emergency first aid

response in an education and caring setting

Learner Guide

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Table of Contents

Preface ................................................................................................................................. 5

Introduction: Understanding the law and first aid ........................................................... 6

A.1 What is First Aid?..................................................................................................... 7

A.2 Legislations and regulations .................................................................................... 7

A.3 Work Health and Safety (WHS) ............................................................................... 8

A.4 Anti-discrimination laws ........................................................................................... 9

A.5 First aid provider’s duties...................................................................................... 11

A.6 Infection control principles and procedures ........................................................... 12

A.7 Requirements for currency of skill and knowledge ................................................ 13

Emergency Numbers ...................................................................................................... 15

The Human Body and Medical Terminology ................................................................. 16

B.1 The systems that make up the human body ......................................................... 16

B.2 Common terminology............................................................................................ 17

B.3 The Recovery Position .......................................................................................... 18

Section 1: Responding to an emergency ...................................................................... 20

1.1 Recognising an emergency .................................................................................. 21

1.1.1 Types of emergencies ....................................................................................... 21

1.1.2 Emergency action plan ...................................................................................... 21

1.1.3 Emergency management flowchart ................................................................... 22

1.2 Identify, assess and minimise immediate hazards to health and safety of self and others ........................................................................................................................... 25

1.2.1 Managing hazards and risks associated with attending an emergency .............. 25

1.2.1 Risk and hazard management ........................................................................... 25

1.3 Assess the casualty and recognise the need for a first aid response ............... 27

1.3.1 Obtaining information ......................................................................................... 27

1.3.2 Secondary examination (visual and verbal survey) ............................................ 28

1.3.3 Establish level of care ........................................................................................ 29

1.4 Assess the situation and seek assistance from emergency response services. 30

1.4.1 Specific management of a person in need at a Road Accident ........................... 30

Section 2: Applying emergency first aid procedures .................................................... 32

2.1 Performing cardiopulmonary resuscitation (CPR) ............................................... 33

2.1.1 Recognise the difference .................................................................................... 33

2.1.2 The chain of survival ......................................................................................... 33

2.1.3 Performing Cardiopulmonary Resuscitation (CPR) ............................................. 34

2.2 Provide first aid according to established first aid principles ............................. 37

2.2.1 General first aid triage principles ........................................................................ 37

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2.2.2 Abdominal Injuries ............................................................................................... 38

2.2.3 Allergic Reactions and Anaphylaxis .................................................................... 39

2.2.4 Asthma ................................................................................................................ 40

2.2.5 Bleeding Control and Basic Wound Care ............................................................ 43

2.2.6 Burns .................................................................................................................. 45

2.2.7 Cardiac Conditions .............................................................................................. 49

2.2.8 Crush Injuries ...................................................................................................... 50

2.2.9 Diabetes .............................................................................................................. 51

2.2.10 Drowning ........................................................................................................... 52

2.2.11 Envenomation ................................................................................................... 53

2.2.12 Australian Snake Bite ........................................................................................ 54

2.2.13 Spider Bite ........................................................................................................ 55

2.2.14 Tick Bites and Bee, Wasp and Ant Stings ......................................................... 58

2.2.15 Jellyfish stings ................................................................................................... 59

2.2.16 Blue-ringed octopus and Cone shell .................................................................. 62

2.2.17 Fish stings ......................................................................................................... 62

2.2.18 Environmental Impacts ...................................................................................... 63

2.2.19 Eye and Ear Injuries .......................................................................................... 70

2.2.14 Febrile Convulsions ........................................................................................... 71

2.2.20 Fractures and Dislocations ................................................................................ 72

2.2.21 Head, Neck and Spinal Injuries ......................................................................... 73

2.2.22 Minor Skin Injuries ............................................................................................. 77

2.2.23 Needle Stick Injuries ......................................................................................... 78

2.2.24 Poisoning and Toxic Substances ...................................................................... 79

2.2.25 Seizures ............................................................................................................ 79

2.2.26 Shock ................................................................................................................ 81

2.2.27 Soft tissue injuries ............................................................................................. 82

2.2.28 Stroke ............................................................................................................... 83

2.3 Ensure casualty feels safe, secure and supported ............................................... 85

2.3.1 Reassurance ....................................................................................................... 85

2.3.2 Cultural Awareness ............................................................................................. 85

2.3.3 Children, the elderly, and the disabled ................................................................ 85

2.3.4 Do Not Revive/Resuscitate (DNR) ...................................................................... 86

2.4 Obtaining consent from a casualty, caregiver, medical practitioners and

emergency services ...................................................................................................... 87

2.4.1 Consent for Treatment ........................................................................................ 87

2.4.2 Treatment without Consent ................................................................................. 87

2.5 Making the casualty as comfortable as possible .................................................. 88

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2.5.1 First aid kit........................................................................................................... 88

2.6 Operating first aid equipment according to manufacturer’s instructions ........... 90

2.6.1 Background information on AEDs ....................................................................... 90

2.6.2 Who should use an AED? ................................................................................... 91

2.6.3 Public Access to AEDs ........................................................................................ 91

2.6.4 Using the defibrillator .......................................................................................... 91

2.7 Monitoring the casualty’s condition ....................................................................... 93

2.7.1 Monitor and respond by first aid principles .......................................................... 93

Section 3: Communicate details of the incident ............................................................ 94

3.1 Convey incident details to emergency services .................................................... 95

3.1.1 Conduct an accurate assessment ...................................................................... 95

3.2 Reporting details of an incident to your supervisor ............................................. 96

3.2.1 When to report a workplace incident .................................................................. 96

3.3 Completing relevant workplace documentation .................................................... 97

3.3.1 Reporting details of an incident .......................................................................... 97

3.3.2 Reporting details of incidents involving babies and children to parents and caregivers ................................................................................................................... 98

3.3.3 Reporting serious incidents to the regulatory authority ........................................ 99

3.4 Maintaining confidentiality of records and information .................................... 101

3.4.1 The Privacy Act 1988 ....................................................................................... 101

3.4.2 Organisational policies and procedures ............................................................. 102

Section 4: Evaluating the incident ............................................................................... 104

4.1 Evaluating the possible psychological impacts when providing first aid ........ 105

4.1.1 Recognising the possible impact on yourself and others following an emergency 105

4.2 Talking with children about their emotions and responses to events .............. 107

4.2.1 Dealing with children’s emotions in an emergency ........................................... 107

4.3 Participating in a debriefing session with your supervisor ............................... 109

4.3.1 Critical Incident Stress Debriefing (CISD) ......................................................... 109

4.3.2 Organisational debriefing process .................................................................... 110

Acknowledgments ......................................................................................................... 111

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Preface

This learning resource provides you with the information needed to assist you with completing the assessments for the unit of competency.

This material has been divided into section which align to the training package rules, including the knowledge and performance criteria which are necessary to complete

the activities and tasks provided to you by your training provider.

It is recommended that you read through this material before you commence your

assessments to familiarise yourself with the information and knowledge you need to have to

complete the various activities and tasks you are given.

Included in this learner guide is a series of review questions to complete. The questions are

designed to reinforce your understanding of the unit of competency and identify areas you may need to re-read.

Note: This guide contains the required information to complete the following units of competency:

• HLTAID001 Provide cardiopulmonary resuscitation • HLTAID002 Provide basic emergency life support • HLTAID003 Provide first aid • HLTAID004 Provide an emergency first aid response in an education and

caring setting

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Introduction: Understanding the law and first aid

The ability to provide first aid in an emergency is an invaluable skill, one that can save lives

and prevent permanent disability. Basic first aid doesn’t mean you need a medical

background or that you should study for hours to understand the human body. Sometimes

it’s enough to assess a scene and relay the information to responders while you keep a

casualty company until those responders arrive, or it could be your skill at performing CPR

to keep a person from suffering brain damage through lack of circulating oxygen. Your

skills as a first aider will assist responders manage a scene more effectively if they are free

to attend to more severe cases.

This guide details the most common events that will require first aid – how to recognise

conditions and how to treat the symptoms. As with any skill, first aid becomes second nature

only if you practice rescue techniques, such as the ability to identify the cause of

envenomation or giving CPR.

After you have completed this guide, you will be able to manage most emergencies calmly,

and instil confidence in bystanders so that they also remain calm and able to help you

manage the scene. You will be able to identify common cases of environmental, health, and

trauma-related incidents with minimal equipment.

In the workplace, your skills will help those who sustain industrial injuries and you can assist

with implementing a risk management plan. Proper and timely first aid care can prevent

many workplace fatalities or permanent disabilities; first aid promotes faster recovery and

saves lives.

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A.1 What is First Aid?

Quick intervention in an emergency can save a life or prevent permanent disability. The action could be as simple as placing the casualty in the recovery position, or giving

CPR until medical help arrives.

First aid is simple medical treatment given as soon as possible to a person who is injured or who

suddenly becomes ill.

Collinsdictionary.com

A.2 Legislations and regulations

There are two organisations within Australia who provide the guidelines and Codes of Practice which the first aid practioner should understand and apply. The two organisations are listed below and will be referred to throughout this guide.

As part of your duty of care as a qualified first aid provider you will need to have a good

understanding of the guidelines and safety. Take some time to read through the guidelines

and Code of Practice to ensure you fully understand your responsibilities when providing first

aid to others.

The Australian Resuscitation Council: They represent all major groups involved in the

teaching and practice of resuscitation; the Royal Australasian College of Surgeons and the

Australian and New Zealand College of Anaesthetists sponsor them. Their guidelines

develop uniformity in techniques and terminology which are applied to first aid in Australia.

ARC Guidelines PDF document provided by Safe Work Australia to manage first aid in the workplace.

Click here for more

Safe Work Australia: They are an Australian Government statutory agency established in

2009. The Safe Work Australia Act 2008, established Safe Work Australia with the primary

responsibility to lead the development of policy to improve work health and safety and

workers’ compensation arrangements across Australia. The Model Code of Practice for

First Aid in the Workplace is part of that mandate.

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Model Code of Practice for First Aid in the Workplace PDF guide on how to manage first aid in the workplace.

Click here for more

As well as the two legislations outlined above, you also need to have knowledge of the peak

clinical bodies which impact first aid services and the laws related to administering first aid to

infants and children:

National Peak Clinical Bodies: There are several peak clinical bodies which provide information on the guidelines required when administering first aid.

The following resource provides you with information on two key peak clinical bodies who assist with the development of first aid in Australia:

List of Peak Bodies National Stroke Foundation (NFS) & National Heart Foundation (NHF)

Click here for more

The Australian Children’s Education & Care Quality Authority (ASECQA): The purpose of

this law is to establish and maintain a national standard for the care and education for all

children in Australia. If you must provide first aid to a child or infant, or work with children as part

of your job, you will need to have a sound understanding of these laws and regulations.

Guide to the Education and Care Services National Law Information on the Education and Care Services National Acts

Click here for more

A.3 Work Health and Safety (WHS)

In the workplace, all workers must follow the legislative and regulatory requirements for

health and safety. It is part of every worker’s duty of care to ensure the safety and wellbeing

of themselves and others.

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You will need to check with your workplace to identify the WHS responsibilities you have regarding your general workplace activities and as a trained first aider.

The Model Code of Practice for First Aid in the Workplace, point 1.2 specifies the duties of a

person who conducts a business or undertaking (PCBU) and the duties their employees

have towards their own health and safety as:

A person conducting a business or undertaking has the primary duty under the

WHS Act to ensure, so far as is reasonably practicable, that workers and other

persons are not exposed to health and safety risks arising from the business

or undertaking.

The WHS Regulations place specific obligations on a person conducting

a business or undertaking in relation to first aid, including requirements to:

• provide first aid equipment and ensure each worker at the workplace has access to the equipment

• ensure access to facilities for the administration of first aid • ensure that an adequate number of workers are trained to administer

first aid at the workplace or that workers have access to an adequate

number of other people who have been trained to administer first aid.

A person conducting a business or undertaking may not need to provide first

aid equipment or facilities if these are already provided by another duty

holder at the workplace and they are adequate and easily accessible at the

times that the workers carry out work.

Officers, such as company directors, have a duty to exercise due diligence to

ensure that the business or undertaking complies with the WHS Act and

Regulations. This includes taking reasonable steps to ensure that the business

or undertaking has and uses appropriate resources and processes to eliminate

or minimise risks to health and safety.

Workers have a duty to take reasonable care for their own health and safety and

must not adversely affect the health and safety of other persons. Workers must

comply with any reasonable instruction and cooperate with any reasonable policy

or procedure relating to health and safety at the workplace, such as procedures

for first aid and for reporting injuries and illnesses.

Source: Safe Work Australia

A.4 Anti-discrimination laws

Anti-discrimination laws have been introduced in Australia to ensure that all persons

regardless of age, sex, race, gender or disability are treated equally and equitably. The

Acts are designed to protected everyone for unfair discrimination, and this includes the

provision of first aid treatment. It is unlawful to refuse treatment to a person on the grounds

which are stipulated in the anti-discrimination legislations.

You will need to research your state or territory for specific legislations related to discrimination. The following table outlines some of the key anti-discrimination legislations

which apply in Australia:

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Legislation and grounds of

Areas covered

discrimination

Age Discrimination Act 2004

Discrimination by age – protects both younger and older Australians.

Also, includes discrimination by age-specific characteristics.

This includes discrimination related to employment, education, and the provision of goods, services and facilities.

Disability Discrimination Act 1992 Discrimination based on any physical, intellectual, psychiatric, sensory, neurological or learning disability,

The Act also covers discrimination involving harassment related to employment and education.

Racial Discrimination Act 1975

Discrimination based on race, colour, descent or national or ethnic origin and in some circumstances, immigrant status.

Racial hatred, defined as a public act/s likely to offend, insult, humiliate or intimidate based on race, is also prohibited under this Act unless an exemption applies.

Discrimination in all areas of public life including employment, provision of goods and services, right to join trade unions, access to places and

facilities, land, housing and other accommodation, and advertisements.

Sex Discrimination Act 1984 Discrimination based on sex, marital or relationship status, pregnancy or potential pregnancy, breastfeeding, family responsibilities, sexual orientation, gender identity, and intersex status.

Sexual harassment is also prohibited under this Act.

Discrimination in employment, including discrimination against commission agents and contract workers, partnerships, qualifying bodies, registered organisations, employment agencies, education, provision of goods, services and facilities, accommodation, disposal of land, clubs, administration of Commonwealth laws and programs, and superannuation.

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A.5 First aid provider’s duties

As a first aider, you will require a clear understanding of what your specific duties are and under what circumstances you are obliged to provide first aid.

General duties

The current legislation does not stipulate that a trained first aid provider (or any other

person) is legally obligated to provide first aid care under all circumstances; the Good

Samaritan and Volunteer laws in each state protect bystanders and trained first aiders

against litigation under the “duty of care” definition.

Australian Red Cross Defining first aider duty of care

Click here for more

When we look at the duty of care concerning first aid, means that the person should provide

first aid care appropriate to their training and that they should take reasonable care when

they assist.

The four general considerations concerning the provision of first aid are:

• Obtain consent • Provide a duty of care • Don’t be negligent – act in good faith to the best of your abilities • Record your actions and outcomes

Duties in the workplace

The Model Code of Practice (Topic A.2: Legislations and regulations), detail the risk

management steps that you should follow when you assess the first aid requirements in

your workplace. It also describes the common workplace hazards that may cause

injuries that require first aid.

In summary, the risk management for first aid is as follows:

1. identifying hazards which have the possibility to result in workplace injury or illness

and the assessment of the type, severity and likelihood of injuries and illness

2. providing the appropriate first aid equipment, facilities and training

3. reviewing your first aid requirements on a regular basis or as circumstances change.

Some of the more common workplace hazards which may require assessment and the provision of first aid treatment are listed in the table below.

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The Model Code of Practice (Table 1, page 6) - common workplace hazards states:

Hazard Potential harm

Manual tasks Overexertion can cause muscular strain.

Working at Slips, trips and falls can cause fractures, bruises, lacerations, dislocations, height concussion.

Electricity Potential ignition source could cause injuries from the fire.

Exposure to live electrical wires can cause shock, burns and cardiac arrest.

Machinery Being hit by moving vehicles, or being caught by moving parts of machinery and can cause fractures, amputation, bruises, lacerations, dislocations.

equipment

Hazardous Toxic or corrosive chemicals may be inhaled, contact skin or eyes causing chemicals poisoning, chemical burns, irritation.

Flammable chemicals could result in injuries from fire or explosion.

Extreme Hot surfaces and materials can cause burns. Exposure to heat can cause temperatures heat stress and fatigue. Exposure to extreme cold can cause hypothermia

and frostbite.

Radiation

Welding arc flashes, ionising radiation and lasers can cause burns

Violence Behaviours including intimidation and physical assault can cause nausea,

shock and physical injuries

Biological Infection, allergic reactions

Animals Bites, stings, kicks, scratches

A.6 Infection control principles and procedures

Following your duty of care responsibilities providing first aid, treatment includes the need to

ensure that you minimise the risk of transmission of any disease to yourself, bystanders, and the casualty.

To achieve this, you need to implement the standard precautions and procedure, ensuring that a basic level of infection control is established and maintained.

Regardless of the casualty's infection status, you need to make sure that these practices are followed.

The ways in which disease can be transmitted include:

• droplet transmissions – this can be from coughing or sneezing

• direct transmission - contact with body fluids – such as blood, saliva and other body

fluids

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• airborne transmission – via ventilation systems and air conditioners • contaminated objects – including needle stick injuries

Standard principles:

When providing first aid, you must always assume that you could be exposed to infection,

so it is essential that you wash your hands with soap and water or apply an alcohol-based

hand solution before proceeding with your treatment.

Where possible, wear appropriate personal protective equipment (PPE) to eliminate

or reduce the risks associated with fluid/body contact. This could include disposable gloves, masks and eye protection.

Procedure:

When preparing for first aid treatments:

• wash your hands • always use PPE such as disposable gloves • ensure any cuts or wounds on your hands are covered

When providing first aid treatments:

• replace torn or damaged gloves • use a resuscitation mask if possible • wash any body fluids as soon as possible and seek medical advice

Following first aid treatments:

• dispose of all used items including dressings, gloves and bandages safely and

according to WHS hazardous material guidelines

• wash your hands thoroughly with soap and water

For the use of resuscitation, masks refer to Topic 2.1 Performing cardiopulmonary resuscitation (CPR)

A.7 Requirements for currency of skill and knowledge

Once you have completed your first aid training and received your certificate, it is important to note that it has an expiry date. In Australia, your first aid certificate is valid for three (3) years, and you will need to undertake a refresher course before its expiration.

In some industries, however, such as the energy sector, there may be a requirement to complete refresher courses every twelve months.

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If you have completed training in a CPR program, you will need to update your skills every twelve months before your certificate expiring.

Only provide first aid which you have been trained in and are confident in carrying out. Know your personal limitations and level of skills and refer an emergency to the appropriate emergency services and an experienced responder if you have any concerns.

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Emergency Numbers

In Australia, there a several numbers which can be accessed and used in an emergency. It

is important that these numbers are only used for emergencies, and all minor incidents or

first aid situations are referred to a medical practitioner or local hospital for further evaluation

and treatment.

Emergency Number

Access and usage

0 over Internet Protocol (VoIP) services

112 GSM mobile phones

106 106 connects to the text-based relay service for people who have a hearing or speech impairment, if you are incapacitated, or when you are in such danger that you cannot speak

1800-088-200 DAN Diving Emergency Service Hotline – within Australia

+61-8-8212 9242 From outside Australia

Visit the Attorney General's web page "Using other emergency numbers” for more details on the various emergency contact methods.

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The Human Body and Medical Terminology

To effectively administer treatment as a first aider you need to understand the human body systems and their critical functions. You will require knowledge of the standard medical

terminology which is used when applying and reporting of first aid treatments.

B.1 The systems that make up the human body

Ten (10) systems make up the human body:

Human Body Overview System

1 Nerves Central nerve system comprises the brain (it controls all functions

in the body) and spinal nerves (it delivers the messages from the brain).

2 Cardiovascular This system is made up of the heart, blood vessels and blood

• Arteries: Deliver the blood from the heart to the body

• Veins: Return the blood to the heart

• Venules, capillaries, arterioles: Located close under the skin in the extremities.

3 Respiratory

This system comprises the airway (mouth, nose, trachea, larynx, bronchi, and bronchioles) and lungs (small air sacs called alveoli).

The system provides the blood with oxygen and eliminates carbon

dioxide.

4 Musculoskeletal

This system is made up of the bones, ligaments,

tendons and muscles. Together they keep the body upright, rigid, and enable motion.

5 Digestive

6 Endocrine

7 Urinary

8 Reproductive

This system comprises the oesophagus, stomach, and intestines. The liver and kidneys are accessories to the digestive system because they convert the nutrients necessary for the body to survive.

Organs and glands that secrete hormones make up this system. The hormones stimulate the body’s functions.

The kidneys, bladder and urinary tract, make up the urinary system. It eliminates waste products and toxins.

The female reproductive system comprises the ovaries, uterus, and vagina.

The male reproductive system includes the testes, seminal vesicle, and penis. The system in both men and women are linked to the endocrine system.

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9 Integumentary Skin, hair, fingernails and toenails make up this system and are

also linked to the endocrine system, which determines the rate of growth and colour.

10 Lymphatic This system collects and eventually flushes out any toxins through

lymph nodes that are in the armpits, neck, and groin. The fluid drains into the bloodstream.

B.2 Common terminology

Throughout this guide, reference will be made to standard medical and first aid

terminology. It is recommended that you become familiar with their meaning and refer to

this table if you're unsure about any phrases throughout this guide.

Term

AED

Casualty

CPR

Meaning

Automated External Defibrillator (used with CPR).

A person who was killed or injured in a war or accident.

A casualty who has suffered terribly as a result of an event or situation.

NOTE: The terms "Casualty", and "patient" may be used interchangeably throughout this document, but they mean the same thing and should be read within context.

Cardio Pulmonary Resuscitation 30 chest compressions to 2 breaths

DRSABCD Danger

Response

Send for help

Airway

Breathing

CPR

Defibrillation

Hyper- Above, more than, in excess

Hypo- Below, less than, deficient

Medical Sudden illness, such as cardiac arrest or heart attack. emergency

Injury

Poisonous

Trauma caused to the body by a violent act, such as a

hammer blow to a finger while doing DIY around the house.

A toxic substance swallowed, inhaled or transferred through the skin (e.g. poison-dart frog, chemical gas, nettle)

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TBSA Total Body Surface Area

Venomous An animal or plant that injects its venom into the body (e.g. teeth, fangs, thorns, barbs).

The following resource provided by the ARC details the medical terminology which may be used as part of first aid procedures:

The Australian Resuscitation Council First Aid Glossary of Terms

Click here for more

B.3 The Recovery Position

When providing first aid treatment, you may need to place the casualty in the recovery position. By putting someone into the recovery position, you will clear and open their airway.

This procedure will also ensure that any vomit or fluid won't cause them to choke.

There are specific steps which need to be followed when placing a casualty into the recovery position.

Standard recovery position

If a person appears to be unconscious, yet still breathing, and present with no other

life-threatening conditions or symptoms, place them in the recovery position.

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To place someone in the recovery position follow these steps:

• put the person on their back, kneel on the floor at their side and

• put the arm nearest you at a right angle to their body with their hand upwards,

towards the head

• tuck their other hand under the side of their head, so that the back of their

hand is touching their cheek • bend the knee farthest from you to a right angle • carefully roll the person onto their side by pulling on the bent knee

• the top arm should be supporting the head, and the bottom arm will stop you rolling

them too far

• open their airway by gently tilting their head back and lifting their chin, and check

that nothing is blocking their airway • stay with the person and monitor their condition until help arrives

Epilepsy Society Recovery Position: Step by Step Guide

Click here for more

Recovery position with a suspected spinal injury

If you suspect a spinal injury, do not attempt to move them until you are assisted by trained emergency service personnel.

If you need to open their airway, place your hands on either side of their head and gently lift

their jaw with your fingertips to open the airway. Take care not to move their neck.

The signs which may indicate a suspected spinal injury include instances where the person:

• has been involved in an incident that's directly affected their spine, such as a fall from

a height or they have been struck directly in the back and are complaining of severe

pain in the neck or back region • cannot move their neck • have feelings of weakness, numbness or paralysis • have lost control of their bladder and bowels

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Section 1: Responding to an emergency

The ability to recognise an emergency, calmly attend to casualties and manage the scene until medical responders arrive, help casualties and bystanders deal with the situation.

Your ability to recognise the signs and symptoms of an immediate medical crisis instils confidence that you can manage the situation and command action from bystanders.

The topics that will be covered in this section include:

1.1 Recognising an emergency

1.2 Identifying, assessing and minimising immediate hazards to the health and safety of

self and others

1.3 Assessing the casualty and recognising the need for first aid response

1.4 Assessing the situation and seeking assistance from emergency response services

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1.1 Recognising an emergency

An emergency can arise at any time – at work, out shopping or do chores at home. A

favourable outcome depends on the proper assessment of the situation and giving

the correct treatment.

Not all emergencies are life-threatening, and some injuries may seem superficial but could, in

fact, be life-threatening. The first thing you should NOT do is panic. Your training and

knowledge in first aid will help you determine the best course of action for any situation.

1.1.1 Types of emergencies

A medical emergency is a sudden illness, such as cardiac arrest or heart attack and an

injury are a trauma caused to the body from a violent act, such as a hammer blow to a finger

while doing DIY around the house.

The symptoms and reactions of the casualty will determine the severity of the situation, but make sure you can determine what unseen injuries the person may have suffered.

As an example, you see a person slip, fall and hit their head. The person may get up

immediately, but they may not be able to recall their name or other relevant information –

this would indicate concussion although there wasn't any blood and they were conscious

always.

1.1.2 Emergency action plan

The recognised acronym to help you remember the steps of an action plan is DRSABCD and is also referred to as, The Basic Life Support Flow Chart).

The table below explains each part of the acronym and the steps which must be followed:

DRSABCD

Danger

Evaluate the scene and make it safe for yourself and the casualty Keep yourself safe by using the correct PPE (e.g. gloves, mask,

apron)

Response

Check for response Obtain consent to administer first aid if responsive

Evaluate signs and symptoms, injuries, and vital signs

Determine need for further assistance

Send for help

If required, call emergency services Describe the scene and give all available information, e.g. cause of

the accident and if there is any leaking fuel

Airway

Clear the airway of any obstructions and place casualty in recovery position

Breathing

Check if breathing is normal If regular, put casualty in recovery position

If not normal, apply CPR

CPR

30 Chest compressions 2 breaths

Continue until medical help arrives

Defibrillation

Apply defibrillator by following voice instructions

Continue until medical help arrives

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1.1.3 Emergency management flowchart

When identifying and assessing the emergency, there is a process which should be followed when assessing the casualty. The following is a sample of an emergency management flowchart which can be used:

1

MANAGE AIRWAY

2

CHECK BREATHING

3.1 APPLY COMPRESSIONS APPLY FULL3.2 ONLY CPR

4

MANAGE APPLY DEFIBRILLATION

TRAUMA

4.a

MEDICAL 4.b EVENT

ENVIRONMENTAL

4.c EVENT

ENVENOMATION

4.d

POISONING 4.e

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The following table outlines the steps which should be taken when implementing the emergency management procedures:

Step Actions 1. Management of the airway takes precedence over everything else (Refer

to ARC Guideline 9.1.6 concerning spinal injuries).

• Clear the airway of obstructions, such as vomit and foreign

objects by following the proper procedures.

2. Check for normal breathing. Look-Listen-Feel. • Look to see if the chest rises and if it does so with a regular rhythm.

• Listen for sounds of gurgling or sighing, and short raspy breaths.

• Feel for air against your cheek if breathing is faint.

3.1 Apply chest compressions only.

• Place the heel of your hand on the breastbone at the centre of the person's chest. Place your other hand on top of your first hand and interlock your fingers.

• Using your body weight (not just your arms), press straight down on their chest by one-third of the chest depth.

• Repeat this until help arrives or the person recovers.

• Try to give 100 chest compressions per minute.

(Source: heath direct)

3.2 Apply full CPR • If you are on your own, then do 30 chest compressions (almost two

compressions per second) followed by two rescue breaths.

• If there is more than one responder available then make sure:

o one person calls triple zero (000) for an ambulance o one person starts chest compressions immediately.

• Then, one person does the compressions, and the other person does the

rescue breaths, continuing the cycle of 30 compressions followed by

two rescue breaths.

• It is very tiring doing CPR, so if possible swap between doing rescue breaths

and compressions, so you can keep going with effective compressions.

Apply defibrillation Prompt defibrillation is a critical part of the resuscitation process, in conjunction

with effective CPR. Some safety points to remember including:

• AEDs must only be used for casualties who are unresponsive and not breathing normally.

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• You must continue with CPR until the AED is switched on the pads have been placed on the torso.

• Follow all instructions when positioning the pads, ensuring they are

not touching each other.

• The responder should follow all AED instructions.

• Care should be taken always to ensure that anyone present does not touch the person during the delivery of the shock by the AED.

• The use of standard adult AEDs and pads can be used for children

aged eight years and over.

• For children aged between one and eight years of age, paediatric pads and an AED with a paediatric capability should be used.

• The positioning of the paediatric pad is placed as per an adult. Follow

the diagram included with your AED instructions to locate where the pads should be positioned on the chest.

• If the AED does not have a paediatric mode or paediatric pads, then

the standard adult AED and pads can be used.

• Do not use an AED on children under one year

4. The various topics in this guide detail the management of the following events – please refer to the specific sections in this guide for more information to address points (4a) to (4e).

4.a Trauma includes – bleeding, burns, head injury, harness suspension incidents,

spinal injury, crush casualty, workplace injuries.

4.b

Medical events include – heart attack, stroke, shock, seizure, asthma,

anaphylaxis, hyperventilation, electrical shock.

4.c

Environment emergencies include – drowning, hypothermia, hyperthermia, cold

injuries, divers and compressed gas.

4.d

Envenomation includes – snake bite, spider bite, insect bites (bees, ticks, wasps,

ants), jellyfish, blue-ringed octopus and cone snails, fish stings.

4.e

Poisoning includes – hazardous chemicals through ingestion, skin punctures,

inhalation of gases.

ACT Ambulance Service Sample Basic Life Support Flow Chart

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1.2 Identify, assess and minimise immediate hazards to health and safety of self and others

Before you move to attend any casualties, it is important to survey the scene. Identifying,

assessing and minimising any immediate hazards takes priority over any treatment.

An unsafe scene will cause additional casualties and pose a health and safety threat your you as the responder and others who are assisting.

1.2.1 Managing hazards and risks associated with attending an emergency

The ARC guidelines on managing an emergency outline the priorities in an emergency which include:

• quickly assessing the situation

• ensuring safety for the responder,

person in need and bystanders (this may mean moving the person in need)

• sending for help (call an

ambulance)

Where more than one person requires attention, THE CARE OF AN UNCONSCIOUS PERSON HAS PRIORITY.

1.2.1 Risk and hazard management

Once you have surveyed the scene and identified any hazards, you need to manage the safety of the emergency scene by implementing a risk management plan.

NOTE:

A Hazard is defined as, anything that is likely to cause an injury or an illness.

A Risk is, the likelihood and consequences of an injury or illness resulting from the hazard.

The process which you need to follow when implementing the risk management plan involves:

• Identifying the hazard – anything that will cause injury or illness

• Identifying the risks – check to see if there is more than one risk factor

• Assess the risks – use appropriate safety precautions

• Control the risks – apply appropriate controls to eliminate or minimise the risks

• Review the controls – ensure that the controls are working and confirm it is safe

to proceed.

There are additional steps you can take when assessing an emergency and establishing the

most reliable approach for providing first aid treatment:

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Step 1: Hazards and dangers

When you survey the scene, look for the following hazards and risks (includes workplace hazards):

Hazards and Risks

Broken glass/sharp edges Other traffic

Power cords/live wires Unstable structures

Sharp objects Damaged vehicles

Fuel Biohazards

Hot water Bombs

Electricity Bullets

Tools Smoke

Chemicals Falling objects (e.g. masonry, rocks)

Fumes/gases Slippery surfaces

Fire Flammable material

Body fluids Aggressive bystander

Climate (e.g. heavy rain, lightning) Drugs (incl. needles/pipes)/alcohol

Step 2: Take charge

If you are the first person on the scene, mobilise any bystanders to help secure the scene. If

somebody else is already in charge, assess their competence (they might have taken on

the role because they were there first but might not necessarily be the best person to

manage the scene).

If another competent person is in charge, very quickly introduce yourself and tell them that you can render first aid, then follow their directions.

Step 3: Get consent

Introduce yourself and if the person is conscious, ask if you can help them. If it is a child or infant, get permission from the parent or guardian before you touch the casualty.

If an adult is unconscious, the implication is that they need your help. Refer to the ARC Guideline 10.5 concerning Legal and Ethical Issues Related to Resuscitation.

Once you have secured the scene and obtained consent to proceed with first aid, assess the responsiveness of the casualty and decide if you need to call for assistance.

Approach to an Incident The safest way to assess the scene and apply triage

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1.3 Assess the casualty and recognise the need for a first aid response

It is impossible to train for every emergency because each situation is unique. However, the basic principles discussed in this section will help you decide if the casualty needs first aid,

or to what extent they need medical attention.

Always keep the DRSABCD actions as well as the Emergency Management Flowchart in mind when you assess a person.

1.3.1 Obtaining information

Successful treatment of a casualty depends on the information you gather about:

• the incident scene • the events that preceded the incident • information about the casualty and treatment.

Ask the casualty and bystanders for as much detail and write down as much information as

you can; don't rely on your memory. You will have to relay the information to medical

personnel, Work Health and Safety (WHS) officer and police so accurate and detailed notes

will help you recall the events surrounding the incident. Although recording information is

vital, the treatment of the casualty is more important.

Important details to remember:

• Don't disturb the scene – police, other safety officers, and medical personnel need the

evidence. If it might be a crime scene, prevent bystanders from contaminating

possible evidence.

• Record information – write down and photograph as much as you can, including: o Location of the casualty at the time of the event o Position of the casualty when you found them

o Any weapons, tools, and obvious causes such as bloody power tools o Evidence of drugs, alcohol, or medication

o Environmental conditions at the time of the incident, e.g. temperature, weather o Contact details and accounts of witnesses to the event

• Record state of the casualty (primary examination) – pulse, breathing, consciousness, skin colour

• Record treatment and the casualty’s response to the treatment

NOTE

Reassure the casualty as you work. Tell them what you are doing and what sensation(s) they can expect.

Reassure the family and other bystanders through your calmness and command of the situation. Work methodically and deliberately.

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1.3.2 Secondary examination (visual and verbal survey)

Once you have done the primary examination of pulse, breathing, consciousness, and skin colour and applied the necessary interventions to stabilise the casualty, you can examine the casualty systematically to establish further interventions.

Using the no-touch technique, gain consent to assess the casualty and explain what you will be doing. Listen carefully to any information they give you and the responses they provide to

you questioning.

If the casualty is unconscious follow the triage procedure (Topic 2.2.2)

• Look for deformity, swelling, pain, discoloration, tenderness, open wounds, cerebral

spinal fluid from the ears (a clear colourless fluid that may have some blood specks),

jaw fracture

• Systematically check from head to toe – o Head o Neck

o Shoulders, chest and back o Abdomen o Arms o Legs

The following table can be used to help record the casualty’s state:

At arrival During treatment After treatment

General Appearance

Pulse

Breathing –

sounds

effort

rhythm

rate

Skin condition

Consciousness

Pain level

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1.3.3 Establish level of care

The following guideline which has been adapted from BayCareUrgentCare.org will help you decide which level of emergency care you need to provide:

When to use Urgent Care or Emergency Room/Call and Ambulance

Urgent Care Emergency Room/Call Ambulance

Allergies Chest pain/discomfort

Colds/flu/fever High fever

Ear pain/infection Shock

Insect bites Severe burns/cuts

Minor asthma Severe headaches

Minor cuts/burns Severe trauma/injuries

Rashes Shortness of breath/difficulty breathing

Sprains/strains/simple fractures Sudden paralysis/slurred speech

Sore throat/cough Unconsciousness

Urinary tract infections Uncontrollable bleeding

Visible fractures

Industrial accident involving chemicals

Severe vaginal bleeding, especially when

pregnant

Electrical shock

Anaphylaxis

Stroke

Inability to dislodge object in throat

Seizures, fitting, or convulsions

Drowning or swimming/scuba accident

Vehicle accidents

Hyper- and hypothermia

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1.4 Assess the situation and seek assistance

from emergency response services

Emergencies can happen anywhere and at any time, with the most common categories being:

• Domestic – 28% cuts; 21% falls off one metre or less; 18% hitting/being hit by something

• Work – 30% sprains or strains; 18% muscle conditions; 16% cuts or open wounds

• Road transport deaths accounted for 1,296 in 2016 of which included:

o Alcohol-induced deaths – 89% road; 41% suicide; 27% assault o Alcohol-related injuries – 52% serious injuries; 32% hospital admissions due

to violence

For more information, you can go to the following website: https://bitre.gov.au/publications/ongoing/road_deaths_australia_monthly_bulletins.aspx

1.4.1 Specific management of a person in need at a Road Accident

As can be seen from the statistics above, road accidents account for most injuries and deaths. As a first aider, you will probably attend to more road-related incidents than any

others.

It is also important to know when the situation is beyond your training and ability to control the scene, e.g. you don't have the right equipment, or there is nobody to help you make the scene safe.

For information on how to determine and manage emergencies, you can access the ARC guidelines.

If you are the first respondent at a road accident there are some critical steps you should take to ensure that you maintain the safety of all those at the scene:

• Approach with caution and make the accident scene as safe as possible.

• Do not touch a vehicle, or attempt to rescue a person from within ten metres of a fallen power line unless an appropriate electrical authority has declared the area safe.

• Use hazard lights, road triangles, or torches to warn oncoming traffic of the accident scene. Use bystanders where it is safe to do so.

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• Turn off the ignition of a crashed vehicle and activate the parking brake. If unable

to activate the parking brake, place a chock under a wheel. Be cautious that

airbags that have not deployed may activate following a crash.

• Remove a motorbike helmet from a person if it is necessary to manage the airway, assist breathing or control bleeding, otherwise leave the helmet on.

• If you can manage an unconscious breathing person within the vehicle, do not

remove them from the vehicle unless there is a threat to life. Clear the airway of

foreign material; maintain head tilt and jaw support and continuously reassess the

airway and breathing.

• If the person in the vehicle is unconscious and not breathing normally

despite opening the airway, remove the person from the vehicle if

possible and commence CPR immediately following the DRSABCD steps.

Surveying an accident scene Applying appropriate emergency process

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Page 31 of 111

Section 2: Applying emergency first aid

procedures

This section sets out the procedures to ensure first aiders are legally protected when they provide any assistance.

The topics that will be covered in this section include:

2.1 Perform cardiopulmonary resuscitation (CPR)

2.2 Provide first aid according to established first aid principles

2.3 Ensure casualty feels safe, secure and supported

2.4 Obtain consent from casualty, caregiver, registered medical practitioners or medical

emergency services where possible

2.5 Making the casualty as comfortable as possible

2.6 Operating first aid equipment according to manufacturer’s instructions

2.7 Monitor the casualty’s condition

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2.1 Performing cardiopulmonary resuscitation (CPR)

You can save the life of a person who had suffered a heart attack or cardiac arrest by giving full cardiopulmonary resuscitation (CPR) or chest compressions only; both methods

save lives.

The ARC (and other medical authorities) recommend that casualties that need CPR take priority during an emergency (ARC Guideline 8).

2.1.1 Recognise the difference

The purpose of CPR is to keep the blood moving around the body to deliver oxygen to the

brain (mainly) and the heart to minimise damage. The brain can survive a maximum of

four minutes without oxygen, and heart muscle suffers damage immediately during a

heart attack (i.e. blood clot damages the cells).

There are some fundamental differences between a cardiac arrest and a heart attack:

Cardiac arrest Heart attack

• Doesn’t breathe • Is breathing

• No pulse • Has a pulse – erratic and weak

• Unresponsive • Responsive

If you witness someone going into cardiac arrest, mouth-to-mouth breathing isn't necessary.

The reason for this is that there is enough oxygen stored within their blood to keep them

going for a while.

2.1.2 The chain of survival

The Chain of Survival is a series of critical steps which are completed, providing the casualty with the best opportunity of survival from a heart attack, cardiac arrest, stroke and foreign body airway obstruction.

The links in the Chain of Survival include:

Early

Early Early

Early CPR Advanced Access Defibrilation Care

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The four links in the Chain of Survival can be summarised in the following way:

Early Access: this includes early recognition of the cardiac emergency and immediate notification to emergency services by calling 000. If available request the

defibrillator.

Early CPR: this will require immediate assessment and support of the airways and commencement CPR by applying the appropriate chest compressions and breaths.

Early Defibrillation: as soon as possible commence using the AED by following the prompts. If a shock is advised, you must ensure that no one is touching the casualty

so check before proceeding.

Early Advanced Care is the care which can be provided by highly trained paramedics who can provide the casualty with drugs, advanced airway procedures

and medical protocols.

2.1.3 Performing Cardiopulmonary Resuscitation (CPR)

Having assessed the casualty and establishing they are non-responsive, you must immediately commence CPR:

Step 1:

The first step is clearing the airway and positioning the casualty on their back to open the airway:

Adults: Place one hand on the forehead and the other hand on the chin using your thumb and fingers in a pistol grip. Gently tilt the head back ensuring that the neck is not moved. The jaw should be held slightly open and tilted away from the chest

Infants: If the infant is less than 12 months old it is important to keep the head in a neutral position. This is done by providing gentle support to the lower jaw at the point of the chin. This will assist in keeping the mouth open.

Step 2:

Once you have cleared the airway, apply the Look-Feel-Listen method to see if there is any movement from the upper abdomen or lower chest and feel for air which is

escaping from the nose and mouth.

Step 3:

Commence CPR continuously until the defibrillator arrives, someone else takes over, or you are advised by a medical professional to cease.

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The internationally accepted compression to ventilation ratio when performing

CPR is; (30) compressions to (2) breaths at a rate of (100 – 120) compressions

per minute. You should only pause the compressions to give breaths.

DRSABCD procedure:

It is also important when performing CPR, to apply the DRSABCD procedure:

DRSABCD Procedure

Danger Evaluate the scene and make it safe for yourself and the casualty

Keep yourself safe by using the correct PPE (e.g. gloves, mask, apron)

Response Check for response

Obtain consent to administer first aid if responsive

Evaluate signs and symptoms, injuries, and vital signs

Determine need for further assistance

Send for help If required, call emergency services

Describe the scene and give all available information, e.g. cause of

the accident and if there is any leaking fuel

Airway Clear the airway of any obstructions and place casualty in recovery position

Breathing Check if breathing is normal

If normal, place casualty in recovery

position If not normal, apply CPR

CPR 30 Chest compressions

2 breaths

Continue until medical help arrives

Defibrillation Apply defibrillator by following voice instructions

Continue until medical help arrives

What if the casualty is pregnant?

CPR can still be performed if the casualty is pregnant. The pregnancy causes the woman’s

uterus to place pressure on the abdominal area if lying flat. Place the casualty on her back

by placing padding under the right buttock. This creates a pelvic tilt to the left side, enabling

effective CPR to be conducted.

Multiple responders

In situations where there is more than one responder is available the following steps should be taken:

• One responder starts CPR while the other –

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o Calls an ambulance – dial 000

o Obtains all available equipment (e.g. AED)

• During multiple responder CPR, it is recommended that you change between

responders every two minutes to prevent fatigue WITHOUT interrupting the rhythm.

When to stop CPR

It is important to continue CPR until:

• the person starts to respond, or breathe normally • continue until you can be replaced or can no longer continue due to exhaustion • a medical officer arrives and takes over CPR procedures • a healthcare professional directs you to cease CPR

Training Aid Australia DRSABCD Process

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The use of a resuscitation mask

When performing CPR, there are standard precautions and infection control principles which must be applied to offer the responder protection against body fluids.

A resuscitation mask is a device that is placed between the responder and the casualty to

avoid contact with saliva, vomit or the transmission of infectious diseases. It is important

to note, however, that transmission from CPR is very low and this should not be a reason

to avoid the process. If the responder does refuse then the use of compression, only CPR

will need to be applied.

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2.2 Provide first aid according to established first aid principles

Being able to give first aid is an invaluable skill. The initial action of giving first aid saves a life or prolongs it until qualified medical assistance arrives.

The fundamental principles of first aid are to:

Fundamental First Aid Principles

Preserve life Yourself: keep yourself safe and out of harm’s way

The casualty: Assess and apply first aid

Prevent Further injuries/harm/condition deteriorating

Promote Recovery by giving first aid

2.2.1 General first aid triage principles

When you arrive at a situation that requires first aid, no matter to what extent, it is important to follow these principles based on first aid triage:

Survey the

scene

• How many casualties? • What type of trauma/medical conditions? • What hazards can you see – electrical cables,

gases, fuel?

• Call for help – dial 000 Take

charge • Organise assistance from bystanders

• Check medical identification bracelets/necklaces

NOTE: If you have triage tape/tags, use it to identify the casualties Implement to medical responders

triage

MINOR DELAYED IMMEDIATE DECEASED Injured but moving Serious but non- Life threatening Not breathing –

around – assess life threatening Unconscious check airway

wounds and vital Respirations Unresponsive No pulse

signs <30/min Blocked airway

Capillary refill Respirations

>2 seconds >30/min

Breathing – give CPR Bleeding – stop bleeding

Conscious – place in recovery position

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UNMC Heroes Triage Basics

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It is important to apply the principles outlined above when administering first aid treatment to casualties, but there are also specific procedures for each type of medical situation.

In the following sub-sections of this topic, we will look at the principles and procedures when applying first aid for each listed scenario.

2.2.2 Abdominal Injuries

The abdominal cavity is located below the ribs and above the pelvis area. There are no bones to protect the abdomen making any injury, high risk including damage to the liver, spleen or stomach.

The types of abdominal injuries you may be faced with include:

Blunt trauma – resulting from an accident, fall or an assault

Penetrating injuries – due to a knife injury, other object or impaled

Infection and illness – caused by infections, internal bleeding or illnesses such as appendicitis.

Symptoms include:

• bleeding wound or another injury, possibly with visible intestines • severe pain and possible muscle spasm across the abdominal wall • nausea or vomiting • bruising of the skin • patient unable to stand and holding the injured area for pain relief • the patient shows other indications of internal bleeding

First Aid Treatment:

• Check the casualty responses and assess them for shock • Call an ambulance on 000

• Assist the patient to lay in a comfortable position and support them with pillows

and blankets for comfort and warmth

• Control bleeding by using direct pressure bandages and if any organs are

protruding, DO NOT touch or try to push them back.

• If the injury is the result of an embedded object leave it in place and provide padding

around the object to stop any bleeding.

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2.2.3 Allergic Reactions and Anaphylaxis

In most cases, allergic reactions are mild to moderate and are not considered life-threatening. Common allergies include hay fever, hives or small localised rashes.

In most minor cases of an allergic reaction, the casualty can take an over the counter antihistamine, eye drops or apply cold compresses on itchy rashes.

In more severe cases a life-threatening reaction known as Anaphylaxis can develop.

Anaphylaxis Anaphylaxis is the most severe form of an allergic reaction and could be life threatening if not treated. This type of reaction should be treated as a medical emergency, and immediate treatment is required.

A severe allergic reaction will usually occur within 20 minutes of exposure to the trigger.

Anaphylaxis is characterised by rapidly developing breathing and circulation issues. It is usually associated with swelling, redness or itching skin, eyes, nose, throat or mouth.

Many substances can cause anaphylaxis but those that are more common include:

• foods (e.g. peanuts, eggs, wheat, seafood) • drugs (e.g. penicillin) • venom from bites (ticks) or sting (e.g. bees, wasps or ants)

Symptoms include:

Anaphylaxis encompasses a variety of symptoms and signs; history and physical findings will help with diagnosis. The onset of this type of reaction can commence from a minute to hours following exposure to the substance.

Signs are highly variable and may include one or more of the following:

• difficult/noisy breathing • wheeze or persistent cough • swollen face and tongue • swelling/tightness in throat • difficulty talking and hoarse voice • persistent dizziness/loss of consciousness and collapse • pale and floppy (young children) • abdominal pain and vomiting • hives, welts and body redness

First Aid Treatment:

People who have been diagnosed with an allergy should avoid any trigger agents and

allergens and have an easily accessible action plan and medical alert device. Whenever

possible, look for this information and implement it as soon as you can, provided it doesn't

delay emergency treatment and getting medical assistance.

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Emergency Treatment

The injection of adrenaline (epinephrine) is the first-line drug treatment in life-threatening anaphylaxis and is a safe and effective management of anaphylaxis.

People who have had a prior episode of anaphylaxis often have prescribed medication, which may include adrenaline (epinephrine) which can be self-administered with the use of an EpiPen.

If the casualty’s symptoms and signs suggest anaphylaxis, manage the casualty as follows:

• Lay the casualty flat; do not allow them to stand or walk. If breathing is

difficult, enable them to sit (if possible). • Prevent further exposure to the triggering agent if possible.

• Administer adrenaline (epinephrine) via intramuscular injection, preferably into

the side of the thigh: • Child less than five years – 0.15 mg • Older than five years – 0.3mg • Call an ambulance – dial 000. • Administer the asthma medication for respiratory symptoms.

• Administer a second dose of adrenaline (epinephrine) by auto-injector to casualties

with severe anaphylaxis whose symptoms were not relieved by the initial dose.

Give the second dose if there is no response 5 minutes after the initial dose.

• If an insect bite or sting caused the allergic reaction or anaphylaxis,

follow Envenomation-Tick Bites and Bee, Wasp and Ant Stings.

• If the casualty becomes unresponsive and not breathing normally, give resuscitation

following the DRSABCD steps.

2.2.4 Asthma

Asthma affects the small airways of the lungs. Those diagnosed with asthma are sensitive to conditions which can narrow the airway, when exposed to certain "triggers", leading to difficulty in breathing.

Three main factors cause the airways to narrow:

1. The muscle around the airway tightens (bronchoconstriction).

2. The inside lining of the airways

becomes swollen (inflammation).

3. The lungs may produce extra

mucus (sticky fluid).

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Certain “triggers” worsen asthma symptoms. Every person's asthma is different and not all people will have the same triggers. Triggers can include:

• Respiratory infection • Irritants (e.g. cigarette, woodfire or bushfire smoke, occasionally perfumed

or cleaning products) • Inhaled allergens (e.g. dust mites, mould spores, animal dander, grass/tree pollen) • Cold air, exercise, laughing/crying • Non-steroidal anti-inflammatory agents (NSAIDs) (e.g. aspirin, ibuprofen) • Sulphite additives (food preservatives) – more common in those

with poorly controlled asthma • *Food allergy – while usually accompanied by other symptoms such as rash

or vomiting, isolated severe asthma may occur as the only presentation and

may result in death • Food colours and flavours • Emotional triggers such as stress

*Most fatal cases of food-induced anaphylaxis occur in those with asthma. In patients with

asthma known to be at risk from anaphylaxis, it is appropriate to administer an adrenaline

auto-injector first, followed by asthma reliever medication. No harm is likely to occur by

doing so in a patient having asthma without anaphylaxis.

Symptoms include:

• A dry, irritating, persistent cough, particularly at night, early morning, with exercise

or activity • Chest tightness • Shortness of breath • Wheeze (high-pitched whistling sound during breathing)

In the event of a severe asthma attack some or all the following symptoms may be

presented:

• Gasping for breath

• Severe tightening of

• the chest

• The inability to speak more than one or two words per breath

• Feeling distressed and anxious

• Little or no improvement after using “reliever” medication

• "Sucking in" of the throat and rib muscles, use of shoulder muscles or bracing with

arms to help to breathe

• Blue discolouration around the lips (can be hard to see if skin colour also changes)

• Pale and sweaty skin

• Symptoms rapidly getting worse or using reliever more than every two hours

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As well as the above symptoms, young children appear restless, unable to settle or become

drowsy. A child may also “sucked in” muscles around the ribs and may have problems eating or

drinking due to shortness of breath. A child also may have severe coughing and vomiting.

An asthma attack can take anything from a few minutes to a few days to develop.

First Aid Treatment:

If the casualty has a personal written asthma action plan, then follow it before any other intervention.

Asthma First Aid Plan

If a casualty has any signs of a severe asthma attack, call

an ambulance straight away and follow the Asthma First

Aid Plan while waiting for the ambulance to arrive.

The most common reliever medication is salbutamol. Try to use the casualty's reliever medication, otherwise, use salbutamol.

If there is no action plan in place, then use the following Asthma First Aid plan.

NOTE: Australia and New Zealand have their action plans with only one variation, but the basic approach is the same.

It is unlikely that “reliever” medication given to somebody without asthma will harm them.

If oxygen is available and you are trained to use it (or call someone who is trained) and follow the Use of Oxygen in Emergencies (ANCOR Guideline 10.4).

If you suspect a severe allergic reaction follow Anaphylaxis – First Aid Management and if they become unresponsive and not breathing normally, follow the DRSABCD steps.

The following is a sample Asthma First Aid Plan which can be followed:

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Asthma First Aid Plan

1 Sit the person comfortably upright.

Be calm and reassuring. Do not leave the person alone.

2 Administer a “reliever” via a spacer

device

Australia 4x4x4 New Zealand 6x6x6

Four separate puffs Six separate puffs Four breaths after each puff Six breaths after each puff

If a spacer is not available, simply use the inhaler. Where available use the casualty's inhaler or borrow on from a

bystander.

3 3 Wait 4 minutes Wait 6 minutes

If little or no improvement, give If little or no improvement, give

another four puffs and breaths another six puffs and breaths

4 If there is no or little improvement, 4 call an ambulance

Australia New Zealand 000 111

Keep giving four puffs every 4 Keep giving six puffs every 6

minutes until the ambulance minutes until the ambulance arrives arrives

Adapted from ANZCOR Guideline 9.2.5 –First Aid for Asthma

2.2.5 Bleeding Control and Basic Wound Care

Our bodies need the correct amount of blood circulating the body to maintain our organs and keep our body functioning normally. There are many causes of bleeding which can be both external and internal

Severe external bleeding

External bleeding can usually be controlled by applying pressure on or near the wound. This will assist with stemming the bleeding until help arrives. The main aim is to reduce blood

loss from the casualty.

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The use of direct pressure is usually the fastest, easiest and most effective way to stop bleeding, but if that doesn’t work, you might have to use other methods to control severe bleeding.

In some circumstances, indirect pressure may be used. If there is an apparently embedded object, use indirect pressure.

First Aid Treatment:

• It is important to use standard precautions (e.g. gloves, protective glasses)

if readily available. • Apply sustained direct or indirect pressure on or near the wound as appropriate. • Lie the patient down if bleeding from the lower limb or for any other severe bleeding. • If the above measures don't control severe bleeding, use a haemostatic

dressing or Tourniquet if available, and you are trained in its use. • Call an ambulance by dialling 000 • If the casualty is unresponsive and not breathing normally, follow

the DRSABCD steps.

The need to control the bleeding is paramount. The risks associated with the use of haemostatic

dressings or a tourniquet are less than the risk of uncontrolled severe bleeding, though these

are temporising measures and transfer to hospital remains of high importance.

Severe internal bleeding

Internal bleeding may be difficult to recognise, but should always be suspected where there

are symptoms and signs of shock (ANCOR Guideline 9.2.3). It includes bruising,

haematomas and the internal bleeding associated with fractures. Severe bleeding may occur

from complications of pregnancy.

Symptoms include:

• Pain, tenderness or swelling over or around the affected area. • The appearance of blood from a body opening –

o Bright red and frothy blood coughed up from the lungs o vomited blood which may be bright red or dark brown "coffee grounds." o blood-stained urine o vaginal bleeding or bleeding from the penis o rectal bleeding which may be bright red or black and "tarry."

First Aid Treatment:

• Internal bleeding may be life-threatening and requires urgent treatment in a hospital so call an ambulance by dialling 000.

• Check their response and conduct a verbal survey listening carefully to what

they are saying about their injury • Look for signs of shock, keep them warm and provide reassurance and comfort • Do not give the casualty any food or liquids • If they vomit or become unconscious, place them on their side • Monitor until emergency services arrive

Nose Bleed (Epistaxis)

Nosebleeds are common and can easily be treated.

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First Aid Treatment:

• apply pressure over the soft part of the nostrils, below the bridge of the nose. • the casualty should lean the head forward to avoid blood flowing down the throat. • the casualty should remain still for at least 10 minutes. On a hot day or after

exercise, it might be necessary to maintain pressure for at least 20 minutes. • If bleeding continues for more than 20 minutes seek medical assistance by dialling

000.

Closed bleeding in limbs - If there is severe bruising to a limb and there is no external bleeding, use a cold pack with pressure if available.

First Aid Treatment:

Apply the following measures until an ambulance arrives:

• Reassure the casualty. • Assist the casualty into a position of comfort. • Monitor the signs of life at frequent intervals. • Administer oxygen if available, and you are trained to do so. • Do Not allow any food or liquids

Basic Wound Care

When attending a wound always wash your hands and use gloves. Follow all standard

infection control precautions and avoid breathing or coughing over the wound. In the event

of serious bleeding from a wound, provide pressure to stop the blood flow and seek medical

assistance.

First Aid Treatment:

For basic wound care, you should:

• Clean the wound with non-fibrous materials or sterile gauze • Do not scrub the wound as you could embed dirt • Apply an antiseptic and cover with a non-stick sterile dressing

2.2.6 Burns

A burn is an injury caused by heat, cold, electricity, chemicals, gases, friction and radiation

(including sunlight). A medical practitioner should assess all infants and children with burns.

A significant burn for this document includes:

• Burns greater than 10% of total body surface area (TBSA). • Burns of special areas – face, hands, feet, genitalia, perineum, and major joints. • Full-Thickness Burns are greater than 5% of TBSA. • Electrical burns. • Chemical burns. • Burns with an associated inhalation injury. • Circumferential burns of the limbs or chest. • Burns in the very young or aged. • Burns in people with pre-existing medical disorders that could complicate

management, prolong recovery, or increase mortality.

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• burns with associated trauma.

Symptoms include:

The general symptoms associated with a burn include:

• Blistering • Red to black marks

• Coughing and breathing difficulties

if exposed to inhalation burns • Reduced responsiveness • Reduces circulation • Shock • Weak vital signs

• Airway obstruction resulting from

swollen airways

First Aid Treatment:

Before you treat a burn, you need to follow steps to ensure your safety:

• Guarantee the safety of the responders, bystanders and the casualty. • Do not enter a burning or toxic atmosphere without appropriate protection. • Stop the burning process:

o Stop, Drop, Cover and Roll o Smother any flames with a blanket

• Move away from the burn source to a safe environment as soon as possible. • Assess the adequacy of airway and breathing. • Check for other injuries. • If safe, and if trained to do so, give oxygen to all casualties with smoke inhalation

or facial injury, following The Use of Oxygen in Emergencies (ANCOR

Guideline10.4).

• Call for an ambulance by dialling 000.

The aims of first aid treatment of burns should be to stop the burning process, cool the burn and cover the burn. This will provide pain relief and minimise tissue loss.

The treatment which should be given for burns include:

Heat/Thermal/Contact Burns

• These include flames, scalds, blasts (hot gas), inhalation injury and direct heat contact

• IMMEDIATELY cool burns with cool running water for 20 minutes.

• If possible, remove all rings, watches, jewellery or other constricting items from

the affected area without causing further tissue damage.

• Remove wet, non-adherent clothing as clothing soaked with hot liquids retains heat.

• Cover the burnt area with a loose and light non-stick dressing, preferably clean,

dry, lint-free (non-fluffy) material, e.g. plastic cling film.

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• Cover unburnt areas and keep the rest of the casualty warm to reduce the risk of hypothermia.

• Where feasible, elevate burnt limbs to minimise swelling.

• DO NOT peel off clothing that is stuck to the body or substances that are burning

• DO NOT use ice or ice water to cool the burn as further tissue damage may result

• DO NOT break blisters

• DO NOT apply lotions, ointments, creams or powders other than hydrogel.

Inhalation Burn

Always assume inhalation injury if there are burns to the face, nasal hairs, eyebrows or

eyelashes, or if there is evidence of carbon deposits in the nose or mouth. Coughing of

black particles in sputum (spit), hoarse voice and breathing difficulties may indicate damage

to the airway.

Suspect an inhalation burn when an individual has been trapped in an enclosed space for

some time with hot or toxic gas, steam or fumes produced by fire, chemicals, etc. An

inhalation injury may result from irritant gases such as ammonia, formaldehyde,

chloramines, chlorine, nitrogen dioxide and phosgene. These agents produce a chemical

burn and an inflammatory response.

Do not assume the burn casualty is stable following an inhalation injury merely because they

are breathing, talking and able to get up. Some agents produce delayed pulmonary inflammation, which may develop up to 24 hours later.

• Move the casualty to fresh air

• Assess and manage the airway.

• Give oxygen if available and trained to do so, following The Use of Oxygen in Emergencies (ANCOR Guideline 10.4).

• Call for an ambulance by dialling 000.

Electrical Burns

Electrical burns (including lighting strike) might cause other injuries to cardiac and respiratory systems, cause loss of consciousness, and result in trauma.

The priorities in the management of the electric shock casualty are to:

• Isolate/turn off the power supply without touching the casualty.

• Commence CPR if required following the DRSABCD steps NOTE: Lightning may cause cardiac arrest so do CPR on the casualty regardless.

• Cool burns if safe to do so, with cool running water for 20 minutes.

• Give oxygen if available and trained to do so, following The Use of Oxygen in

Emergencies (ANCOR Guideline 10.4).

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• Call an ambulance by dialling 000.

Radiation Burns

Radiation burns may be caused by:

• solar ultraviolet radiation (sunburn) • welder’s arc • lasers • industrial microwave equipment • nuclear radiation.

Cover radiation burns with a clean, dry dressing to prevent infection.

Chemical Burns

Government regulations on hazardous substances and WHS require the manufacturer or

importer of a hazardous chemical to prepare a Safety Data Sheet (SDS) for the chemical. A

supplier must provide an SDS to a workplace at the time of first supply or upon request.

These SDS’s provide first aid information specific to each chemical and include information

relevant to eye contact, skin contact, inhalation and ingestion.

The aim of first aid for chemical burns is not to cool the burn but to dilute the chemical.

• Avoid contact with any chemical or contaminated material,

using appropriate personal protection equipment (PPE).

• Remove the casualty to a safe area.

• Remove the chemical and any contaminated clothing and jewellery as soon as practical.

• Brush powder chemicals from the skin.

• Without spreading the chemical to unaffected areas, IMMEDIATELY run cool running

water directly onto the area for one hour or until the stinging stops.

• Apply a non-adherent dressing even if no burn mark is evident.

• If the chemical enters the eye, open and flush the affected eye(s) thoroughly with

water for as long as tolerated and refer the casualty for urgent medical attention. If

only one eye is affected, then flush with the head positioned so as the affected eye is

down to avoid the spread of the chemical to the unaffected eye. It is more important

to flush the eye than an immediate transfer for medical care.

• Refer to instructions on the container for further specific treatment.

• If available, in hard copy or on the internet, refer to Safety Data Sheets (SDS) for specific treatment.

• Call the Poisons Information Centre for further advice – dial 13 11 26

• DO NOT attempt to neutralise either acid or alkali burns, because this will increase

heat generation which may cause more damage.

• DO NOT apply cling wrap or hydrogel dressings to chemical burns.

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2.2.7 Cardiac Conditions

A heart attack is when one of the coronary arteries that supply the heart muscle is suddenly

blocked – partially or completely. Because of the interruption of the blood supply, there is an

immediate risk of life-threatening changes to the heart rhythm. If not corrected quickly there

is also a risk of serious, permanent heart muscle damage. To reduce the chance of sudden

death from heart attack, urgent medical care is required – "every minute counts".

A heart attack is different from but may lead to, cardiac arrest. Cardiac arrest is when the heart ceases its action (it stops beating).

Survival after a heart attack can be improved by first aid treatments and clot-dissolving

medications that clear the blocked artery, restore blood supply to the heart muscle and

limit damage to the heart.

First aid and medication are most effective if provided as soon as possible after the onset of symptoms; these benefits decline with delays in treatment.

For some casualties, sudden cardiac arrest may occur as the first sign of heart attack – however most experience some warning signs.

It is important to note:

• a heart attack can occur without chest pain or discomfort as one of the symptoms

• the most common symptom of a heart attack without chest pain is shortness of breath

• a person who experiences a heart attack may pass off their symptoms as "just indigestion."

If the warning signs are severe, get worse quickly, or last longer than 10 minutes, act immediately.

Symptoms include:

The casualty may experience one or a combination of these symptoms:

• pain or discomfort • pale skin • shortness of breath • nausea or vomiting • sweating • feeling dizzy or light-headed

Discomfort or pain in the centre of the chest may start suddenly, or come on slowly over

minutes. It may be described as tightness, heaviness, and fullness or squeezing. The pain may

be severe, moderate or mild. The pain may be limited to or spread to, the neck, throat, jaw,

either or both shoulders, the back, either or both arms and into the wrists and hands.

Atypical chest pain is defined as pain that does not have a heaviness or squeezing sensation (typical angina symptoms), precipitating factors (e.g., exertion), or usual location.

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First Aid Treatment:

Manage a heart attack/cardiac arrest as follows:

• Encourage the casualty to stop what they are doing and to rest in a comfortable position.

• If the casualty has been prescribed medication such as a tablet or oral spray to treat

episodes of chest pain or discomfort associated with angina, assist them to take this as they have been directed.

• Call an ambulance if symptoms are severe, get worse quickly or last longer than 10 minutes.

• Stay with the casualty until the ambulance or on-site resuscitation team arrives.

• Give aspirin (300 mg); dissolvable aspirin is preferred. Only withhold if the casualty is known to be anaphylactic to aspirin.

• Administer oxygen if there are visible signs of shortness of breath, and you

are trained to do so, following The Use of Oxygen in Emergencies (ANCOR Guideline 14.2).

• If practical and resources allow, locate the closest AED and bring it to the casualty.

If the casualty is unresponsive and not breathing normally, commence resuscitation following the DRSABCD steps.

2.2.8 Crush Injuries

Many situations can cause crush injuries, including being trapped in a vehicle, falling debris, industrial accident or by prolonged pressure to a part of the body due

to an immobile person's body weight.

Crush syndrome refers to the multiple problems that may subsequently develop, most

commonly because of crush injuries to the limbs, particularly the legs. A disruption of the

body’s chemistry causes crush syndrome and can result in kidney failure, heart attack and

other problems.

The likelihood of developing acute crush syndrome is directly related to the compression time; therefore, the casualty should be released as quickly as possible, irrespective of how long they had been trapped.

The management of crush casualties include:

• Ensure the scene is safe, and that there is no risk of injury to the responder or bystanders.

• Call an ambulance – dial 000

• If it is safe and physically possible, remove all crushing forces from the casualty as soon as possible.

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• A casualty with a crush injury may not complain of pain, and there may be no external

signs of injury. All casualties who have been subjected to crush injury, including their

body weight, should be taken to hospital for immediate investigation.

• Keep the casualty warm and treat any bleeding.

• Continue to monitor the casualty’s condition (topic 1.3.2). If the casualty becomes

unresponsive and is not breathing normally, follow the DRSABCD steps and

Secondary Examination.

DO NOT leave the casualty except if you need to call an ambulance.

DO NOT use a tourniquet for the first aid management of a crush injury.

NOTE: Crushing force to the head, neck, chest or abdomen can cause death from heart

failure or being unable to breathe so you need to remove the cause of the crushing

immediately. Although the casualty may appear to be alert and not distressed, there is a risk

of deterioration, so you need to monitor the casualty's condition until medical help arrives.

2.2.9 Diabetes

A person with diabetes does not produce insulin properly which results in the blood glucose levels being higher. Treatment for diabetes may be necessary if the sugar levels are too low or they are producing too much insulin.

Symptoms Include:

• Confusion • Light-headedness • Dizziness • Weakness • Trembling or shaking • Sweating • Headaches • Lack of concentration

If not treated symptoms could elevate to include:

• Slurred speech • Confusion • Loss of consciousness • Fits

First Aid Treatment:

• DRS ABCD & Call 000. • Give the casualty a sugary drink such as soft drink or fruit juice. • If no improvement after 5 minutes, give more. • If they are unconscious, do not put anything in the mouth.

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2.2.10 Drowning

Drowning is when a person is unable to breathe because they are submerged/immersed in

liquid. Drowning outcomes are classified as death, morbidity and no morbidity – the latter

two now referred to as "non-fatal drownings". ("Morbidity" is the undesirable side effect or

rate of illness associated with an event).

The most serious consequence of drowning is an interruption of the oxygen supply to the brain. Early rescue and resuscitation by trained first responders or first aiders at the scene

offer the casualty the best chance of survival.

First Aid Treatment:

• Remove the casualty from the water as soon as possible but do not endanger your

safety. Throw a rope or something to provide buoyancy to the casualty. Call for

help; plan and effect a safe rescue.

• In minor incidents, the casualty will cough and spontaneously resume breathing after they are removed from the water.

• In more severe incidents, assess the casualty. If unconscious or not breathing normally, commence resuscitation following the DRSABCD steps.

• Place the casualty on their back with their head at the same level, rather than in

a head down position. This decreases the likelihood of regurgitation and vomiting

and is associated with increased survival.

• The casualty should generally not be rolled onto their side to assess their airway and

breathing. The advantage of assessing the casualty’s airway without turning them onto

their side (i.e. leaving them on their back or in the position in which you found them) is

that it takes less time to perform, avoids movement and is easier to teach.

• The exceptions to this would be where fluid (blood or water) obstructs the airway or

other foreign matter (sand, debris, vomit). In this instance, roll the casualty onto their

side to clear the airway. Open the mouth and turn it slightly downwards to allow

gravity to drain any foreign material

• A drowned casualty will often vomit and regurgitate. Reassess the casualty if they

are on their side. If they start breathing again, leave them on their side with

appropriate head tilt. If they aren’t breathing normally, roll the casualty onto their

back and start resuscitation.

• Don’t delay or interrupt CPR. Do not empty a distended stomach by applying

external pressure. Do not attempt to expel or drain clear water or frothy fluid that may

re-accumulate in the upper airway during resuscitation.

• Carefully monitor any casualties who appear to have been successfully rescued

and resuscitated to detect a relapse into cardiopulmonary arrest. This can occur in

the minutes or hours following return of spontaneous circulation and breathing, due

to persisting lung damage and hypoxic injury (lack of oxygen) to the heart.

• Call an ambulance (dial 000) for all casualties of an immersion event, even if seemingly minor or the casualty appears recovered.

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2.2.11 Envenomation

Envenomation is the term used to describe the bites or stings which are given by poisonous

insects (e.g. bees, spiders and ticks) and venomous animals including snakes and jellyfish.

Pressure Immobilisation Technique

The Pressure Immobilisation Technique (PIT) was introduced for the treatment of

Australian snakebites and is suitable for other elapid snakebites. It is also recommended for

envenomation by many other animals. Applying the PIT stems the flow to the lymph system – this is how venoms gain access to the circulation.

It has also been shown that there may be inactivation of certain venoms and venom components when the injected venom remains trapped in the tissues by the pressure bandage.

When applying the Pressure Immobilisation Technique (PIT) follow the recommendations below:

Recommended NOT Recommended

To manage bites and stings by the following For the first aid management of: creatures:

All Australian venomous snakes, Other spider bites including Redback

including sea snakes

Jellyfish stings

Funnel-web spider

Fish stings including stonefish bites

Blue-ringed octopus

Stings by scorpions, centipedes or

Cone shell beetles

Immediate and intense local pain

Local redness and swelling

Management

If resuscitation is needed it takes precedence over the PIT (refer to ARC Guideline 8). However, the resuscitation team should apply PIT as soon as

possible to potentially minimise further venom flow.

If on a limb, apply a broad pressure bandage over the bite site as soon as possible.

Elasticised bandages (10-15cm wide) are preferred over crepe bandages, if neither

are available, use clothing or other material. The bandage should be firm and tight –

you should be unable to easily slide a finger between the bandage and the skin.

To further restrict lymphatic flow and to assist in immobilisation of the limb, apply a further

pressure bandage, commencing at the fingers or toes of the bitten limb and extending

upward covering as much of the limb as possible. Apply the bandage over existing clothing

if possible. The purpose of this bandage is to further restrict lymphatic flow and assist

immobilisation. (Alternatively, use a single bandage to achieve both pressure on the bite

site and immobilisation of the limb. In this method, apply the bandage initially to the fingers

or toes and extend it up the limb as far as possible including the bite site).

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Splint the limb, including joints, on either side of the bite, to restrict limb movement. Incorporate the splint material under the layers of the bandage. For the upper limb, use a sling.

Keep the casualty and the limb completely at rest. Bring transport to the casualty if possible.

Transport the casualty to medical care, preferably by ambulance. If alone, the casualty should

apply the pressure immobilisation bandage as completely as possible over the bite site and

affected limb. They should keep immobile until assistance arrives. If they are unable to obtain

urgent help to come to them, then apply local pressure if possible, immobilisation is

contraindicated, and they should move themselves to seek immediate help.

DO NOT remove the bandages or splints before evaluation in an appropriate hospital environment.

If the bite is not on the limb, firm direct pressure on the bite site may be useful.

DO NOT restrict breathing or chest movement and do not apply firm pressure to the neck or head.

Note:

DO NOT cut or excise the bitten area, or attempt to suck venom from the bite site.

DO NOT wash the bitten area.

DO NOT apply an arterial tourniquet. (Arterial tourniquets that cut off circulation to the limb, are potentially dangerous and are not recommended for any bite or sting in Australia.)

The following are some standard treatments for envenomation.

2.2.12 Australian Snake Bite

Many of the snakes found in Australia are capable of lethal bites to humans. These include Taipans, Brown snakes, Tiger Snakes, Death Adders, Black snakes, Copperhead snakes, Rough Scaled snakes and many sea snakes.

Snakes produce venom in modified salivary glands, and the venom is forced out under

pressure through paired fangs in the upper jaw. Snake venoms are complex mixtures

of many toxic substances that can cause a range of effects in human casualties. The

life-threatening early effect in Australian snakebite is neurotoxic muscle paralysis,

which kills by causing breathing failure.

Other significant effects include:

• bleeding due to the blood, not clotting • muscle damage causing kidney failure

Symptoms Include:

The bite may be painless and without visible marks. Other symptoms and signs may include:

• paired fang marks, but often only a single mark or a scratch mark may be present

(localised redness and bruising are uncommon in Australian snake bite) • headache • nausea and vomiting

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• occasionally, initial collapse or confusion followed by partial or complete recovery • abdominal pain • blurred or double vision, or drooping eyelids • difficulty in speaking, swallowing or breathing • swollen tender glands in the groin or axilla (cavity) of the bitten limb • limb weakness or paralysis • respiratory weakness or respiratory arrest

NOTE

You may not see life-threatening effects for several hours. However when massive envenomation occurs,

especially in children, symptoms and signs may appear within minutes.

First Aid Treatment:

The responder should:

• Keep the casualty calm and at rest, reassured and under constant observation

• commence resuscitation if necessary, following the DRSABCD steps

• apply the Pressure Immobilisation Technique

• transport the casualty to a medical facility, preferably by ambulance

• DO NOT cut or incise the bite

• DO NOT use an arterial tourniquet

• DO NOT wash or suck the bite

Snake identification

Identification of venomous snakes can be made from venom

present on clothing or the skin using a Venom Detection Kit. For

this reason, do not wash or suck the bite or discard clothing.

DO NOT kill the snake for purposes of identification, because medical services do not rely on visual identification of the snake species.

Antivenom is available for all venomous Australian snake bites.

2.2.13 Spider Bite

The bites of many different Australian spiders may cause pain, but only bites from some spiders are an immediate threat to life.

If serious symptoms or signs develop from any spider bite, transport the casualty to hospital.

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Funnel-web spiders

A bite from a large (more than 2cm), dark-coloured spider, especially in the regions of

Sydney, Blue Mountains, the central-, northern-, and southern highlands or south

coast of NSW, or south-eastern Queensland, should be considered as a dangerous

bite and treated immediately.

Symptoms Include:

Symptoms and signs of Funnel Web spider bite may include:

• pain at the bite site, but a little local reaction • tingling around the mouth • profuse sweating • copious secretion of saliva • abdominal pain • muscular twitching • breathing difficulty • confusion leading to unconsciousness

NOTE

Life-threatening effects may occur within 10 minutes.

First Aid Treatment:

The responder should:

• call an ambulance • apply Pressure Immobilisation Technique immediately

If the casualty is unresponsive and not breathing normally, follow DRSABCD steps.

NOTE

Antivenom is available for treatment of Funnel-web spider envenomation.

Red-back spiders

This spider (approximately 1cm body length) has a characteristic red, orange or

pale stripe on its back. A bite may threaten the life of a child, but apart from pain, is rarely serious for an adult.

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Symptoms include:

Symptoms and signs may include:

• immediate pain at the bite site which becomes hot, red

and swollen • intense local pain which increases and spreads • nausea, vomiting and abdominal pain • profuse sweating, especially at the bite site

• swollen tender glands in the groin or armpit of the

envenomated limb

NOTE

Local pain develops rapidly at the bite site and may become

widespread, but the venom acts slowly, so a serious illness is

unlikely in less than 3 hours. Pain can be treated with antivenom in

a hospital where resuscitation facilities are available. A related

species, the Cupboard Spider (resembles the red-back spider

without the stripe) may be treated with the Red-back spider

antivenom.

First Aid Treatment:

The responder should:

• keep the casualty under constant observation • apply an ice or cold compress to lessen the pain (for periods of no longer

than 20mins) • transport the casualty to a medical facility, preferably by ambulance, if the

casualty is a young child, or has collapsed, or pain is severe.

NOTE

The Pressure Immobilisation Technique is not used because the

venom acts slowly and any attempt to retard its movement tends to

increase local pain. Antivenom is available for Red-back spider

envenomation.

White-tailed spiders

Although the bite of the White-tailed spider may cause severe inflammation, it has created, contrary to popular opinion, very few cases of severe local tissue destruction. Other

causes of necrotic ulcers should be sought especially when a spider has not been seen.

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NOTE

The Pressure Immobilisation Technique is not used because the

venom acts slowly and any attempt to retard its movement tends to

increase local pain. Antivenom is available for Red-back spider

envenomation.

Other Australian spider bites

All other spider bites should be treated symptomatically (Apply ice or cold compress to lessen the pain.)

2.2.14 Tick Bites and Bee, Wasp and Ant Stings

Single stings from a bee, wasp or ant, while painful, seldom cause serious problems except

for persons who have an allergy to the venom. Multiple insect stings can cause severe pain

and widespread skin reaction. Stings around the face can cause serious envenomation and

difficulty breathing even if the person is not known to be allergic.

It is important to remember that bee stings with the venom sac attached continue to

inject venom into the skin, while a single wasp or ant may sting multiple times.

Ticks can inject a toxin that may cause local skin irritation or a mild allergic reaction, however, most tick bites cause few or no symptoms.

In susceptible people, tick bite or other bites/stings may cause a severe allergic reaction or anaphylaxis, which can be life-threatening. This can also occur in casualties

with no previous exposure or apparent susceptibility.

Symptoms include:

Minor Major/Serious

Immediate and intense local pain Allergic reaction/anaphylaxis

Local redness and swelling Abdominal pain and vomiting in the case of allergic reaction to insect venom

First Aid Treatment:

• If the casualty is unresponsive and not breathing normally, commence resuscitation,

follow the DRSABCD steps • If the casualty has signs of anaphylaxis, follow Anaphylaxis Guideline • In the case of a bee sting, remove the sting, by any means, as quickly as possible • In the event of tick bite, if there is no history of tick allergy, immediately remove the

tick • If the casualty has a history of tick allergy, the tick must be killed where

it is, rather than removed • If in a remote location, consult a healthcare professional • Move casualty to a safe place • Apply a cold compress to help reduce pain and swelling

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• Monitor the casualty for signs of allergic reaction (difficulty speaking, breathing

difficulties, collapse and generalised rash) • Refer the casualty to hospital if sting is to the face or tongue

2.2.15 Jellyfish stings

Jellyfish discharge their venom through thousands of microscopic stinging capsules called

nematocysts. These are located on the surface of tentacles and in some species on the

body of a jellyfish. Nematocysts contain coiled threads (tubules) loaded with venom. Upon

contact, the nematocysts “discharge” their tubules into the casualty’s skin like mini-harpoons.

The more tentacles that contact the skin, the more venom is injected.

Stings cause immediate, sharp pain and an acute inflammatory skin reaction at the sting site

consisting of redness, wheat and swelling which may progress to local skin destruction.

Some stings cause rapid collapse.

In Australia, life-threatening stings generally occur in tropical areas, with few in the southern regions. Because of their smaller body size, children are at greater risk of the effects of

envenomation.

Most stings are not serious, and you should avoid over-treating minor stings. Wearing a full-body Lycra suit or equivalent provides excellent protection from stings.

Tropical envenomation

Two types of jellyfish in Australian waters cause potentially fatal envenomation.

1. Box Jellyfish

The Australian Box Jellyfish, (Chironex fleckeri), has a large (box-like) bell up to 20 x 30 cm

and multiple tentacles. It inhabits estuarine and on-shore coastal waters. Contact with

tentacles causes severe immediate pain and whip-like marks on the skin. A sting with

several metres of tentacles can cause respiratory and cardiac arrest within a few minutes.

2. Jellyfish causing Irukandji syndrome

There are approximately ten offshore and onshore jellyfish (including Carukia Barnes and

species of the Carybdea, Malo, Alatina, Gerongia and Morbakka genera) are known or

suspected to produce an "Irukandji syndrome". These jellyfish have only four tentacles, and

some are too small to be seen by the casualty.

A minor sting on the skin with no tentacle visible is followed in 5-40 (typically 20-30) minutes

by severe generalised pain (often cramping in nature), nausea and vomiting, difficulty

breathing, sweating, restlessness and a feeling of "impending doom". Casualties may

develop heart failure, pulmonary oedema (accumulation of fluid) and hypertensive stroke.

Symptoms include:

Since it is usually difficult to recognise which species of jellyfish caused a sting, management is based on the risk of serious stings in the known geographical distribution of

dangerous species.

Tentacles on the skin:

• Long lengths of easily visible large tentacles on the skin in association with severe pain should be regarded as Box jellyfish tentacles.

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• If there are large numbers of blue jellyfish washed up on the beach or floating on the surface of the water, tentacles are probably of a Physalia species (“Bluebottle”).

• Tentacles from hundreds of other species of jellyfish in Australian waters are difficult to identify. Often no tentacles remain.

Skin markings:

A variety of skin markings are associated with the stings of various jellyfish species and could include the following:

• an inconspicuous mark which may develop a red flare • an inconspicuous mark with goose pimples or an orange-peel appearance • an inconspicuous mark with profuse sweating only at the sting site • an irregularly shaped blotchy wheal • white wheals with a surrounding red flare • multiple whip-like wheals on the skin or a “frosted ladder pattern” suggest a sting by

a box jellyfish • later blistering or darkening of the sting pattern.

Pain:

• skin pain is generally immediate and varies in intensity from mild irritation

to severe sharp or burning pain • generalised muscle aches • severe muscle cramps in the limbs, chest and abdomen

Other symptoms include:

• difficulty breathing, or cease breathing • cardiac arrest • severe pain • restlessness and irrational behaviour • nausea and vomiting, headache • physical collapse • profuse sweating, sometimes only in the sting area

First aid treatment:

• No standard nationwide recommendation for first aid can be made because of differences between jellyfish species around Australia.

• In most cases, first aid providers would unlikely be able to identify the jellyfish.

• In the tropics, because of the risk (even if small) that a potentially lethal jellyfish has stung the casualty, the priority must be to preserve life.

• If the species causing the sting cannot clearly be identified as harmless, or due to a “Bluebottle”, it is safer to treat the casualty with vinegar.

• Outside the tropics, where huge numbers of non-life-threatening stings occur, the primary objective is pain relief with heat or cold.

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Treatment in Tropical Australia

• Remove the casualty from the water and restrain if necessary.

• If casualty has more than a localised single sting, or if they look/feel unwell, call an

ambulance – dial 000 and seek assistance from a lifesaver/lifeguard if available.

• Assess casualty and commence resuscitation as necessary following the DRSABCD steps.

• Liberally douse/spray the stung area with vinegar for 30 seconds to

neutralise invisible stinging cells, then pick off remaining tentacles.

• If the casualty has apparently been stung by a "Bluebottle" (see above) and is

assessed as having a localised sting, is stable and not requiring an ambulance, do not apply vinegar and manage the casualty as per stings in non-tropical Australia.

• If vinegar is unavailable, pick off any tentacles (this is not harmful to

the responder) and rinse the stung area well with seawater.

• Apply a cold pack or ice in a dry plastic bag to relieve pain. Do not allow or apply

fresh water directly onto the sting because it may cause discharge of undischarged

nematocysts.

• Antivenom is available for Chironex fleckeri and other multi-tentacled box jellyfish

stings. In tropical coastal areas, hospitals and ambulances carry antivenom.

• Patients who initially appear stable but experience severe symptoms in the following

30 minutes may be suffering Irukandji syndrome and need urgent medical care.

Treatment in non-tropical Australia

• Keep the casualty calm and resting, reassure and keep under constant observation.

• Do not allow rubbing of the sting area.

• Pick off any tentacles (this is not dangerous to the responder) and rinse sting area well with seawater to remove invisible nematocysts.

• Place the casualty’s stung area in hot water (no hotter than the responder can

comfortably tolerate) for 20 minutes.

• If the local pain is not relieved by heat, or if hot water is not available, apply a cold pack or ice in a dry plastic bag.

• If pain persists or is generalised, if the sting area is large (half of a limb or

more), or involves sensitive areas (e.g. the eye) call an ambulance – dial 000 and seek assistance from a lifesaver/lifeguard if available.

NOTE

For advice concerning any marine envenomation contact Australian Venom Research Unit 1300 760 451

Or Poisons Information Centre 13 11 26

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2.2.16 Blue-ringed octopus and Cone shell

Blue-ringed octopuses (Hapalochlaena spp) inhabit all Australian coastal waters and are often found in tidal pools. If handled, these small animals may inflict a potentially fatal bite, injecting venom stored in salivary glands.

Many species of cone shell (Conus spp) are found in tropical waters. They fire a dart-like barb to deliver venom when handled.

Although different, venoms from both these creatures can cause paralysis and death from respiratory failure within 30 minutes. Treat casualties by following the DRSABCD steps.

Symptoms include:

• a painless bite: a spot of blood visible • lips and tongue become numb • the progressive weakness of muscles of respiration leading to inadequate or

cessation of breathing.

First aid treatment:

• Call an ambulance – dial 000 • Keep the casualty calm and at rest, reassured and under constant observation. • Use the Pressure Immobilisation Technique • Transport the casualty to a medical facility, preferably by ambulance. • If the casualty is unresponsive and not breathing normally, follow

the DRSABCD steps.

NOTE: Despite being unable to move, the casualty may be able to hear.

2.2.17 Fish stings

Many fish have spines with attached venom glands. When trodden upon, the spines of the marine Stonefish (Synanceia spp) and the freshwater Bullrout (Notesthes robusta) penetrate deeply and deposit venom causing excruciating pain.

General cardiovascular toxic effects can occur but are rare. Handling these or similar fish is also potentially dangerous.

The barbed spines on the tails of stingrays can inflict a severe gash or penetrate stab injury

with subsequent venom-induced tissue death. Organs and blood vessels may be damaged,

and fragments of the spine may remain in the wound requiring surgical removal. Injuries

usually occur when the casualty stands on an unseen fish, pulls a captured fish into a boat

or swims too closely over a fish on the sea floor.

AUSTRALIAN VENOM RESEARCH UNIT

For urgent advice concerning any marine envenomation, call the Australian Venom Research Unit 24 hour advisory line

1300 760 451

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Symptoms include:

• intense pain, leading to irrational behaviour • swelling • sometimes a local grey/blue discolouration • an open wound • bleeding

First aid treatment:

• Call an ambulance – dial 000.

• If the sting is in the trunk (chest, abdomen), assess the casualty for signs of bleeding and treat for bleeding.

• If there is an embedded object (e.g. a barb from a stingray sting), do not remove it as

it may be plugging the wound and restricting bleeding. Place padding around or

above and below the object and apply pressure over the pads.

• If the sting is on a limb, place the casualty's stung hand or foot in hot water (no hotter than you can comfortably tolerate).

• Transport the casualty to a medical facility.

If the casualty is unresponsive and not breathing normally, follow the DRSABCD steps.

NOTE

DO NOT use the Pressure Immobilisation Technique. Antivenom is available for stonefish envenomation

2.2.18 Environmental Impacts

Prolonged exposure to cold and heat can result in the body being affected externally (frostbite, sunburn, etc.) and internally (dehydration, organ failure). In severe cases, early

treatment is critical to survival.

Hypothermia

For the human body to function normally, it needs to maintain its temperature at about 37⁰C.

Hypothermia is when the body’s temperature falls below 35⁰C. As the body’s temperature

falls, systems and organs progressively fail until death occurs, usually from cardiac arrest.

Infants and elderly people are at greater risk.

Hypothermia may develop acutely (suddenly), for example falling into icy water, or gradually (being in cold conditions for a long time).

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Causes of Hypothermia include:

Cause Description

ENVIRONMENTAL Exposure to cold, wet, or windy conditions; cold- water immersion/submersion; exhaustion.

TRAUMA Trauma, immobility and burns.

DRUGS Alcohol and sedatives.

NEUROLOGICAL Stroke and altered consciousness.

ENDOCRINE Impaired metabolism.

SYSTEMIC ILLNESS Severe infections, malnutrition.

Adapted from: ARC Guideline 9.3.3: Hypothermia First Aid Management

Symptoms include:

• Mild hypothermia:

o casualty shivering o pale, cool skin o impaired coordination o slurred speech o responsive but with apathy or confusion

• Moderate to severe hypothermia:

o the absence of shivering o increasing muscle stiffness o progressive decrease in consciousness o slow irregular pulse o hypotension

In more severe cases, the casualty may have dangerous cardiac arrhythmias (a change

in the heartbeat), cardiac arrest, and fixed dilated pupils. The casualty may appear dead, particularly if they have a weak, slow pulse.

First aid treatment:

• Call an ambulance – dial 000. • Remove from the cold environment. • General and supportive treatment with application of basic life support where

appropriate; this must continue until the casualty has warmed up. • Remove sources of heat loss such as wet clothing, contact with cold surfaces and

move them out of the wind. Do not remove wet clothing if there is no dry blanket or

another cover. Apply insulation between body and the environment (e.g. blanket). • Dry the casualty if wet.

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• Give warm oral fluids (not alcohol) and only if the casualty is fully conscious

and able to swallow. • If the casualty is in a remote location and not shivering the responder

should initiate active rewarming. • Cautiously apply a source of external heat such as heat pack or body-to-body

contact. • To avoid burns, ensure that any heat source is warm or tepid but not hot • Do not place the casualty in a warm bath.

Hyperthermia (Heat Induced Illness)

The very young and aged are more prone to heat-induced illness, and the causes of Hyperthermia include:

• excessive heat absorption from a hot environment • excessive heat production from metabolic activity • failure of the cooling mechanism • an alteration in the body’s set temperature

Factors that may contribute to heat-induced illness include:

• excessive physical exertion • hot climatic conditions with high humidity • inadequate fluid intake • infection (particularly a viral illness) • inappropriate environments (e.g. unventilated hot buildings) • wearing unsuitably heavy, dark clothing on hot days • drugs that affect heat regulation

To prevent hyperthermia on warm, humid or hot days:

• keep infants and the elderly in cool, ventilated areas and provide ample oral fluids • wear a hat and light coloured, loose-fitting clothing during physical exertion and

outside activities • take adequate fluids during exertion on hot days and don’t wait until you’re thirsty

If you are participating or organising sporting events:

• allow six weeks for acclimatisation with progressive exercise before a competition • avoid vigorous exercise during a viral illness • plan to conduct events in the early morning or late evening or the

cooler months of the year • provide regular drink stations • follow the support guidelines relevant to specific activities

At no time should children or the elderly be left unattended in parked cars.

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For workers in outdoor or potentially hot environments, refer to occupational health guidelines relevant to the environment. Work environments that may be particularly prone to causing hyperthermia and heat-induced illness include those in which:

• there is a high ambient temperature with reduced air movement

• the worker is exposed to radiant heat, and there is difficulty in maintaining adequate

hydration (refer to Work Safe Australia's Model Code of Practice: First Aid in the Workplace

Symptoms include:

The body usually controls mild elevation in body temperature with sweating, which allows cooling by evaporation.

Once a person becomes too dehydrated to sweat, their body temperature can rise rapidly and dramatically.

The following chart lists the symptoms which casualties may experience:

Heat Exhaustion

Heat Stroke

• Fatigue with a headache, nausea, vomiting, malaise and dizziness

• Might collapse • Body temperature BELOW 40°C • Conscious state will become normal once the

casualty is lying down

MAY LEAD TO UNCONSCIOUSNESS AND DEATH

• All organs may be affected • Lack of sweating • Body temperature ABOVE 40°C • Altered conscious state • Hot, dry skin (sometimes excessive sweating) • Collapse

First Aid Treatment:

The management of heat-induced illness is aimed at removing the cause and assisting the normal cooling mechanisms of evaporation, conduction, radiation and convection.

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Heat

Exhaustion

Heat Stroke

Febrile

Convulsions

• lie the casualty down in a cool environment or the shade • loosen and remove excessive clothing • moisten the skin with a moist cloth or atomiser spray • cool by fanning • give water to drink if fully conscious • call for an ambulance (dial 000) if not quickly improving

LIFE THREATENING

• call for an ambulance • resuscitate following the DRSABCD steps (topic 1.1.2)

• place the casualty in a cool environment

• moisten the skin with a moist cloth or atomiser spray and

fan repeatedly • apply wrapped ice packs to neck, groin and armpits

• Give 3-8% carbohydrate electrolyte fluid (any commercially

available "sports drink") for the treatment of exertion related heat stroke. If fluid is unavailable, provide water

• treat as for seizure

Compressed Gas – Divers

“Compressed gas” divers breathe gas (usually air) while under water. Most commonly,

divers use SCUBA (Self-contained Underwater Breathing Apparatus) and breathe from

cylinders carried underwater, but the breathing gas can also be supplied from the surface

(hookah supply).

Whichever method is used to provide the gas, breathing compressed gas underwater can

lead to several unique medical problems, the most significant being decompression illness

(DCI) and pulmonary barotrauma (rupture of small airways).

Also, divers may suffer from the same aquatic mishaps as swimmers, snorkelers and boating enthusiasts.

Decompression illness and pulmonary barotrauma require special first aid considerations, including the prompt and continued administration of near-100% oxygen.

Diagnosis of the exact problem in an ill or injured diver is often unnecessary for effective first

aid; it is, however, important to also consider non-diving-related causes of the presenting condition.

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Symptoms include:

Decompression Illness Pulmonary Barotrauma

extreme fatigue chest pain

numbness/tingling or altered sensations difficulty breathing

a headache or other body pain, coughing especially at or around joints

the blueness of lips and tongue

poor balance or coordination (cyanosis)

irritability, confusion or reduced voice changes consciousness

difficulty swallowing

weakness, paralysis, physical collapse

rash “crackly” skin around neck (crepitus)

speech, visual or hearing disturbances reduced responsiveness

signs/symptoms of decompression

illness may also be present

First aid treatment:

• If the casualty is unconscious, manage as per DRSABCD steps. A casualty of DCI

may regain consciousness and appear to have recovered, but you still need to

maintain them for suspected DCI because they might relapse.

• Promptly provide as close to 100% oxygen as possible and continue to do so until the ambulance arrives and takes over management.

• If you suspect DCI, lay the casualty flat on their back, if possible.

• Seek immediate diving medical advice by calling the DAN Diving Emergency

Service hotline on 1800-088-200 (from within Australia) and +61-8-8212 9242 (from

outside Australia).

• Aid with any transfer to a recompression chamber if requested.

• If the casualty is alert and stable, but you suspect they are suffering from DCI,

they may drink non-alcoholic fluids, such as water or isotonic/electrolyte fluids (as

long as they have no stomach cramps, nausea, urinary retention or paralysis).

• Record details of the dive(s), what first aid you gave and the casualty’s response to first aid.

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NOTES

• The Divers Alert Network (DAN) Diving Emergency Services

(DES) is a 24-hour emergency hotline which is available to for all

diving related injuries. The hotline will provide emergency advice

and management processes to treat diving injuries and illness.

• Entonox (50% nitrous oxide gas in oxygen) must not be used in diving accidents

Cold Injuries

Exposure to cold conditions can lead to a generalised cooling of the body (hypothermia) or localised cold injury. The latter may be either cold Injury (frostbite) or Non-Freezing Cold

Injury (NFCI or trench foot).

Causes of frostbite

The formation of ice crystals, which blocks small blood vessels causes frostbite. The area's most commonly affected are those exposed to cold, windy conditions (e.g. the

face, incl. ears), and those with the most peripheral blood supply (e.g. fingers and toes).

The two simple classifications of frostbite are:

a) superficial frostbite in which only the skin is frozen and can still be moved about the underlying tissue (and is most cold injury cases in Australia)

b) deep frostbite which involves deeper tissues.

First Aid Treatment:

Superficial Frostbite Deep Frostbite

Get out of the cold weather by seeking Seek shelter. Get out of the cold and shelter wind.

DO NOT rub the frozen tissue. Remove any constrictive or damp wet clothing and replace with clean, dry

DO NOT use radiant heat to rewarm the clothing if available. part.

Wrap in warm blankets and give warm It is important to re-warm any affected fluids by mouth. areas immediately by gently placing

fingers in the opposite armpit or placing If the tissue is still frozen when a warm hand on the frost-nipped cheek presented, the best tissue survivability or ear. Feet can be reheated on the results from placing the injured part in a warm abdomen (under clothing) of a warm water bath with circulating water companion. Rewarming can be very (40-42°C, that is, comfortably hot to the painful. back of a responder's hand) until the

affected part thaws. This may take 30 Ensure that re-freezing does not occur. minutes or more. Such management is

Once the colour and consistency of the best achieved under hospital conditions skin have been restored, the person can where infection-control and adequate safely resume normal activity provided pain relief can be provided.

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they increase their insulation and are especially vigilant against recurrence.

If the tissue has spontaneously thawed by the time of presentation (as is often the case) the 40-42°C water bath is not required, but affected tissue can be cleaned and bathed at a more comfortable temperature (30-35°C). Rewarming can be very painful.

Elevate the affected part.

DO NOT use radiant heat to rewarm the part.

DO NOT break blisters.

NEVER thaw a part of the body if there is a likelihood of it being refrozen. The thawing and refreezing results in more tissue damage than if left frozen for several hours.

Causes of non-freezing cold injury

The prolonged exposure to temperatures which are above freezing can result in the limbs being affected by trench foot. When first observed, the injured area will appear pale, pulseless and immobile, but not frozen.

First aid treatment:

The treatment of Non-Freezing Cold Injury is still controversial, as there isn't a single method of treatment which has demonstrated higher rates of tissue survivability.

• Dry the foot well. Keep the body warm but the foot cool.

• DO NOT let the casualty walk on affected feet. Rather let them lie down with their feet elevated.

• DO NOT use radiant heat to rewarm the part.

2.2.19 Eye and Ear Injuries Eye injuries can occur as the result of trauma, foreign objects, chemicals, or a direct contact.

Ear injuries are the result of several causes including foreign objects, trauma, ruptured ear drums and illness including ear infections.

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Symptoms Include:

Eyes Ears

Redness Nausea

Swelling Dizziness

Bruising around eye area Fever

Pain Bruising

Bleeding

Swelling

Redness

Earache

Severe pain and loss of hearing

First Aid Treatment:

Eyes Ears

For black eyes, apply cold compresses Call an ambulance For minor foreign objects flush with a mild Reassure and monitor the casualty until

saline solution medical attention is received

If the object cannot be removed with the Do not block any drainage from the ear

above method seek medical attention

Do not try to remove the object using sharp Do not put liquid in the ear or try to clean or

objects such as tweezers wash the affected area

For major foreign objects, cover the eye

and call for an ambulance by dialling 000

2.2.14 Febrile Convulsions

Febrile convulsions only occur in a minuscule percent of children aged between 6 months and six years of age and are caused by fevers which rise rapidly.

For mild cases, all that is required is reassurance and protection from injury.

Symptoms in severe cases Include:

• Shaking or jerking • Fever • Clamminess

First Aid Treatment:

• Place casualty on side until jerking ceases

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• Do not restrain the casualty • If seizure lasts more than 5 minutes’ call for an ambulance by dialling 000

2.2.20 Fractures and Dislocations

A fracture is caused by the breaking or bending of a bone which also has damage to the soft tissue around the break.

Symptoms Include:

• Closed or simple fractures – where the bone is broken, and there is no opening to the exterior through a wound and no injury to other body organs

• Open or compound fractures – where broken bones have exposed the air as a result

of being pushed through the skin or the wound leads to the bone. This type of

fracture is considered serious due to any associated bleeding and the increased

possibility of infection.

• Complicated fractures – which includes damage to the veins, arteries, nerves and the lining of the bone

First Aid Treatment:

Use of splints

The use of a splint in situations where an ambulance will be at the scene within a reasonable

period say an hour or so is not required.

Wooden splints are also not recommended because they are: • Hard to find at accidents, • They will cause pressure sores if not properly padded, • They are painful to apply, and • The ambulance officers will have to remove them to use their equipment

Treatment of limb when ambulance is not available

o Approach incident o Call ambulance immediately o Check circulation below injury (pulse and skin) o Obtain materials for splinting and bandaging

o If the casualty experiences severe muscle spasm

• talk to and reassure the casualty regularly • take hold of the foot of injured limb and • gently pull foot down from hip • straighten limb • hold limb

o Apply the bandages and splint between the legs, remembering to pad the area.

• Broad bandage above the fracture • broad bandage below the fracture • broad bandage to the joint above the fracture • broad bandage to the joint below the fracture

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• tie all knots over padding

o Frequently check circulation below bandages o Reassure casualty and treat poor perfusion

Dislocation usually occurs when a bone shifts out of place because of twisting, forcing or

pulling motions.

Symptoms include:

• Abnormal or no movement • Deformity - (sometimes) • Swelling • Bruising • Shortening of limb (Legs) • Crepitus - a coarse grating sound which should be prevented • Loss of power, movement or control • Pain • Tenderness

First aid treatment:

• Approach incident • Take history and examine injury • If necessary call ambulance immediately • Rest the casualty and the limb but do not try to straighten the limb • Check circulation below injury (pulse and skin) • Keep casualty warm and provide comfort and reassurance • Do not let them eat or drink anything until medical assistance has been sought

2.2.21 Head, Neck and Spinal Injuries Head neck and spinal injuries may be caused in several ways including, falls, assaults,

motor vehicle crashes, sporting injuries and, less commonly, penetrating injuries.

A casualty may sustain a significant head injury without loss of consciousness or loss

of memory (amnesia). Therefore, do not use unconsciousness or memory loss to

define the severity of a head injury or to guide management.

Head Injury

For a casualty with a head injury, the initial first aid treatment should include an assessment

and check the airways, making sure the neck is kept still until help arrives – refer to

DRSABCD and Secondary Examination. Advise all casualties of head injuries to seek

assessment by a health care professional or at a hospital.

Suspect a brain injury if the casualty sustained a blow to the head, has signs of injury to the

head or face such as bruises or bleeding, or is confused or unconscious. A brain injury may

be present without external signs of injury to the head or face. Serious problems may not

be evident for several hours after the initial injury.

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First Aid Treatment:

• Call an ambulance (dial 000) if the

person has lost consciousness or has displayed altered consciousness at any time, no matter how brief.

• A casualty who has sustained a head injury, whether there has been a loss of consciousness or altered consciousness, should be assessed by a health care professional.

• Manage an unconscious casualty

according to the DRSABCD steps.

• Ensure that the airway is clear.

• Protect the neck while you

maintain a clear airway.

• Identify and control any significant bleeding with direct pressure if possible.

Suspected Spinal Injury

The spine is made up of 33 separate bones, known as vertebrae, extending from the base of the skull to the coccyx (tailbone). Each vertebra surrounds and protects the spinal cord (nerve tissue).

Always suspect a spinal injury in the overall management of trauma casualties. The risk of worsening the spinal injury in the prehospital period is probably less than previously thought, yet to minimise the extent of the secondary injury, be cautious when you move a casualty.

Spinal injuries can occur in the following regions of the spine:

• the neck (cervical spine) • the back of the chest (thoracic spine) • the lower back (lumbar spine)

The most vulnerable area of injury is the cervical spine. This type of injury should be suspected in any casualty presenting with injuries above the shoulders. More than half of

spinal injuries occur in the cervical region.

Suspected spinal injuries of the neck, particularly if the casualty is unconscious, pose a dilemma for the responder because correct principles of airway management often cause some movement of the cervical spine.

The most common causes of spinal cord injury are:

• a motor vehicle, motor cycle or bicycle incident as an occupant, rider, or pedestrian • an industrial accident (i.e. workplace) • a dive or jump into shallow water or water with obstacles or being "dumped" in the

surf • a sporting accident (e.g. rugby, falling from a horse) • a fall from greater than a standing height (e.g. ladder, roof)

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• falls in the elderly population • a significant blow to the head • a severe penetrating wound (e.g. gunshot)

The symptoms of a spinal injury can be determined by two factors: firstly, it is important to

determine the location of the injury and secondly the seriousness of the injury. You will need

to assess if there is a bone injury or associated spinal cord injuries including whether the

spinal cord is complete. It is important to allow the qualified medical service to make this

assessment, especially in those with an altered state of consciousness.

Symptoms include:

• pain, • tingling and numbness in the limbs • Weakness or inability to move the limbs • nausea • headache or dizziness • altered or absent skin sensation

Signs of spinal injury include:

• head or neck in an abnormal position • signs of an associated head injury • altered conscious state • breathing difficulties • shock • change in muscle tone, either flaccid or stiff • loss of function in limbs • loss of bladder or bowel control • priapism (erection in males)

If a spinal injury is suspected:

1. Call an ambulance – dial 000

2. Manage the airway, breathing and circulation

3. Manage the spine

Being aware of potential spinal injury and handling the casualty carefully, with attention to spinal alignment, is the key to minimising harm.

The Conscious Casualty

Tell the casualty to remain still but do not physically restrain them if they are uncooperative. Those with significant spinal pain will likely have muscle spasms, which act to splint their injury. Keep the casualty comfortable until help arrives.

If it is necessary to move the casualty from danger (e.g. out of the water, off the road),

carefully support the injured area and restricting movement of the spine in any direction.

Only qualified first aid personnel and health care professionals who are trained in the

area of spinal injuries and car should move the casualty.

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The Unconscious Casualty

Management of the airway takes priority over any suspected spinal injury. Move the head GENTLY into a neutral position to obtain a clear airway. If the casualty is breathing

but remains unconscious, place them in the recovery position.

Handle the casualty gently without twisting. Aim to maintain spinal alignment of the head and

neck with the torso, both during the turn and afterwards. If you need to open the airway, use

manoeuvres that are least likely to cause the cervical spine to move. Try the jaw thrust and

chin lift before you try to tilt the head.

Spinal Immobilisation Techniques and Devices

a) Cervical Collars

NOTE

As stated by ANCOR:

All responders in the pre-hospital environment review their approach to

the management of suspected spinal injury regarding SR (semi rigid)

cervical collars. Consistent with the first aid principle of preventing further

harm, the potential benefits of applying a cervical collar do not outweigh

harms such as increased intracranial pressure, pressure injuries or pain

and unnecessary movement that can occur with the fitting and application

of a collar. In suspected cervical spine injury, ANZCOR recommends that

the initial management should be manual support of the head in a natural,

neutral position, limiting angular movement. In healthy adults, padding

under the head (approximately 2cm) may optimise the neutral position. (ANCOR Guideline 9.1.6 – Management of Suspected Spinal Injury)

The potential adverse effects of SR cervical collars increase the longer it is used and include:

• movement of the neck and head while sizing and fitting of the collar • discomfort and pain • restricted mouth opening and difficulty swallowing • airway compromised if the casualty vomits • any pressure on the neck veins causing cranial pressure. • hiding potential life-threatening conditions

b) Spinal Boards

Rigid backboards placed under the casualty can be used by first aiders should it be

necessary to move the casualty. The benefits of stabilising the head will be limited unless

you control the motion of the trunk effectively during transport. DO NOT leave the casualty

on rigid spinal boards. Otherwise healthy persons left on spine boards develop pain in the

neck, back of the head, shoulder blades and lower back and are at risk of pressure

necrosis. Conscious casualties may attempt to move around trying to get more comfortable

which could cause further injury.

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Paralysed or unconscious casualties are at higher risks of developing pressure necrosis due

to their lack of pain sensation. Strapping restrict breathing and should be loosened if

compromising the casualty. Casualties might be more comfortable on a padded spine board,

air mattress or bead-filled vacuum bed; some ambulance services use these devices

successfully.

c) Log Roll

The log roll is a manoeuvre performed by a trained team, to roll a casualty from a supine (face up) position onto their side, and then flat again, so that the person can be

examined or a back board placed underneath their back, or to remove a back board.

d) Children

After road traffic accidents, leave conscious infants in their rigid seat or capsule until

ambulance personnel can assess them. If possible, remove the infant seat or capsule

from the car with the infant/child in it. Children under eight years of age may require

padding under their shoulders (approximately 2.5cm) for neutral spinal alignment.

2.2.22 Minor Skin Injuries

Luckily, most of these injuries are not serious and can be handled with some simple first-aid

interventions at home. Bumps and bruises are damage that occurs in the soft tissue under

the skin.

Under the following conditions, there is no need to call for medical assistance when a person

suffers a cut, scrape, bump, or bruise:

• The injury is small (less than 1/2 inch around).

• There is no bleeding or only slight bleeding. Make sure you follow the universal

guidelines, such as wearing protective gloves, preventing the spread of HIV or any

other dangerous infections. (See How to Treat Wounds and Stop Bleeding for first

aid care for bleeding.) • The victim is not in excessive pain. • The victim does not feel numbness or tingling. • The person is not suffering any paralysis. • The victim does not seem to have any broken bones or dislocation at the joints.

However, there are times when a physician's care is needed. In general, call

your physician for skin injuries that are:

• Bleeding heavily and do not stop after five to 10 minutes of direct pressure. • Deep or longer than 1/2 inch. • Located close to the eye. • Large cuts on the face. • Caused by a puncture wound or dirty or rusty object. • Embedded with debris such as dirt, stones, or gravel. • Ragged or have separated edges. • Caused by an animal or human bite. • Excessively painful. • Showing signs of infection such as increased warmth, redness, swelling, or drainage.

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Symptoms Include:

• Cuts slice the skin open which causes bleeding and suffering. Scrapes are

not as severe but are more painful due to nerve endings being affected.

• Punctures are stab wounds. This causes pain, but may not result in bleeding.

Bruises cause black and blue or red skin. As they heal, the skin turns yellowish-

green. Pain, tenderness, and swelling also occur.

First aid treatment:

For Minor Cuts and Scrapes

• Clean the wound carefully and thoroughly using soap and water.

• Apply pressure for up to ten minutes to halt any bleeding, sing a sterile

gauze which has been moistened.

• If bleeding persists, lift the part of the body with the cut higher than the heart, if

practical. • When the bleeding has ceased, you can apply appropriate first aid cream if available.

• Place one or more bandages on the cut with the edges of the cut skin touching but

not overlapping. If possible use a butterfly bandage to • keep the area clean

For Punctures that Cause Minor Bleeding

• Allow the wound to bleed to clean itself. • Remove the object (e.g., splinter) using clean tweezers.

• Two to four times a day, clean the wound area with soapy water. Dry well and apply

an antibacterial cream. • For Bruises

For bruising

• apply a cold back to the area as soon as you can, using the cold pack for 10 minutes

with 30 to 60-minute intervals. • It is important to • rest the bruised area and keep elevated above the level of the heart if able to. • There is no need to bandage a bruised area.

2.2.23 Needle Stick Injuries

If you suffer a needle stick injury (i.e. a contaminated needle penetrates the skin), immediately wash the area with soap and water.

If water is not available, clean the area with hand wipes followed by an alcohol-based liquid or gel if available.

Immediately report to your GP or local emergency department.

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2.2.24 Poisoning and Toxic Substances

Poisons can enter the body several which includes:

• Ingestion – swallowing poisonous substances • Injection – drug use • Absorption – via contact with skin • Inhalation – breathing in toxic gases, fumes, vapours

Symptoms Include:

The types of symptoms will vary depending on the type of poison or toxic substance but includes:

• Unconsciousness • Nausea • Vomiting • Burning sensation in mouth and throat • Headaches • Blurred vision • Seizures • Respiratory arrest • Cardiac arrest

First Aid Treatment:

• Open their airway • Wash poison from face and if inhaled, allow a sip of water to wash out mouth • Using a mask commence CPR • Only use compressions if a face mask is not available • If poison is inhaled avoid breathing the fumes and seek fresh air for the casualty

immediately • If swallowed, wash out the mouth – DO NOT make them vomit • If contact with skin, remove contaminated clothing, wash skin with running cold water

2.2.25 Seizures

A seizure is a sign of abnormal brain activity, which can be caused by many problems. Up to 10% of the population is likely to experience a seizure at some time in their life.

A seizure may occur when the normal pattern of electrical activity of the brain is disrupted. This can cause changes in sensation, awareness and behaviour, or sometimes

convulsions, muscle spasms or loss of consciousness.

Seizures vary widely, and most are over in less than 5 minutes. Not all seizures are due to epilepsy and can be associated with:

• lack of oxygen (hypoxia) • onset of cardiac arrest • medical conditions affecting the brain, e.g. low blood sugar, low blood pressure, head

injury, neurological diseases, epilepsy • trauma to the head • some poisons and drugs • withdrawal from alcohol and other substances of dependence

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• fever in children under six years

Symptoms include:

Seizures can take many forms including:

• muscle spasms which can produce rigidity; if the casualty is standing this could

cause them to fall • arm, leg and head jerking motions • shallow breathing • biting of the tongue or dribbling • incontinence of urine and/or faeces • changes in conscious state from being fully alert to confused, drowsy, or total loss of

consciousness • changes in behaviour where the casualty may make repetitive actions

like fiddling with their clothes

Generalised seizures usually involve the entire body and cause a loss or marked alteration

in consciousness. Some generalised seizures result in life-threatening problems with airway

or breathing, or risk of trauma from muscle spasms or the casualty loses normal control of

posture and movement.

Febrile convulsions are usually associated with a fever and will resolve without the need

for treatment. Febrile convulsions occur in about 3% of children aged between six months

and six years. Children who suffer a febrile seizure are not at increased risk of epilepsy.

First aid treatment:

If the casualty is unresponsive and not breathing normally, follow the DRSABCD steps.

If the casualty is unconscious and actively seizing, you should:

• follow the casualty’s seizure management plan, if there is one in place • manage the casualty according to DRSABCD guidelines • call an ambulance by dialling 000

Further actions:

• manage the casualty as for any unconscious person DRSABCD • remove the casualty from danger or remove any harmful objects which might

cause secondary injury to the casualty • note the time the seizure starts • protect the head • avoid restraining the casualty during the seizure unless this is essential to

prevent injury • lay the casualty down and turn the casualty on their side when practical • maintain an open airway • reassure the casualty who may be dazed, confused or drowsy • call an ambulance – dial 000 • monitor the casualty

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Putting a child in a bath during a convulsion is dangerous so do not undertake this process

Do not insert any objects into the child's mouth during the seizure

A seizure in water is life threatening. If the seizure occurs in water:

• support the casualty in the water with the head tilted, so the face is out of the water • remove the casualty from the water as soon it is safe to do so • call an ambulance – dial 000 • if the casualty is unresponsive and not breathing normally, follow the

DRSABCD steps.

2.2.26 Shock

Shock is a loss of effective circulation, which results in inadequate tissue oxygen and nutrient delivery and causes life-threatening organ failure. Some conditions that may cause

shock include:

a) Loss of circulating blood volume (hypovolaemic shock):

• severe bleeding (internal and/or external) • primary or multiple fractures or major trauma • severe burns or scalds • severe diarrhoea and vomiting • severe sweating and dehydration

b) Cardiac causes (cardiogenic shock):

• heart attack • dysrhythmias (abnormal heart rhythm)

c) Abnormal dilation of blood vessels (distributive shock):

• severe infection • allergic reactions • serious brain/spinal injuries • fainting

d) Blockage of blood flow in or out of heart (obstructive shock)

• tension pneumothorax • cardiac tamponade • pulmonary embolus • in pregnancy, compression of large vessels by the uterus

Symptoms include:

The symptoms will vary, depending on the severity, nature an underlying cause. Symptoms can include:

• dizziness • thirst • anxiety • restlessness • nausea

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• breathlessness • feeling cold • collapse • rapid breathing • the rapid pulse which may become weak or slow • cold, sweaty skin that may appear pale • confusion or agitation • decreased or deteriorating level of consciousness • vomiting

First aid treatment:

1. Lay the on their back. If they are unconscious place, place them in the recovery

position

2. Control any bleeding promptly

3. Call an ambulance – dial 000

4. Administer treatments relevant to the cause of the shock, e.g. electrical shock

5. Administer oxygen if available and trained to do so (ARC Guideline 10.4)

6. Maintain body temperature (prevent hypothermia)

7. Reassure and constantly re-check the casualty’s condition for any change.

8. If the casualty is unresponsive and not breathing normally, follow DRSABCD steps

9. For individuals with shock who are lying on their back and who have no trauma, use

PLR (passive leg raises) to provide a transient (less than 7 minutes) improvement.

Specific Management of Electric Shock

If there are any concerns about electricity when assessing the situation apply the following:

• When power lines are in contact with a vehicle or a person, do not approach until the

authorities declare the situation safe. All bystanders must remain at least ten meters

clear of any material which is electrified including metal and water.

• In domestic situations, it is essential that you separate the person in need quickly

from the electricity supply. Switch off the power supply and if safe to do so,

unplug the appliance from the electrical outlet. Until the power is off, avoid direct

skin contact with the person or any conducting material.

• If the person is unresponsive and not breathing normally, follow the DRSABCD steps.

• Anyone suffering from an electrical shock must be referred to medical authorities for assessment and treatment if needed.

• If a person has been struck by lightning conduct an assessment. If unresponsive and not breathing normally, follow the DRSABCD steps.

2.2.27 Soft tissue injuries

Soft tissue injuries vary in type and severity and include sprains and strains. The cause of

soft tissue injuries includes sudden jolts or twisting which causes the fibres to overstretch.

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Symptoms Include:

• tearing of ligaments • swelling • bruising • pain • unable to bear weight

First Aid Treatment:

For the treatment of soft tissue injuries apply the RICE procedure:

Rest – Make the casualty comfortable and restrict/stop movement

Ice – For first 24 to 48 hours use ice or cold packs every two hours for 15 minute periods

Compression – Bandage the area firmly with a roller bandage. Ensure you extend the bandage above and below the injury

Elevation – If possible elevate the injured area above the level of the heart

2.2.28 Stroke

Stroke is considered the second most common cause of death in Australia. As stroke occurs, when the blood supply to part of the brain is suddenly disrupted or when there is spontaneous bleeding from a blood vessel within the skull.

An acute blockage of a blood vessel within the brain causes approximately 80% of strokes. Stroke is a medical emergency.

When the blood supply to a part of the brain is interrupted, that area of the brain is damaged

and may die. The surrounding brain tissue is also affected and is at risk of dying. However,

if the blockage can be cleared quickly and blood supply restored, the amount of damage to

brain tissue can be significantly reduced.

Rapid recognition, protection and support of the airway, breathing and circulation, and

rapid access to definitive stroke care can all contribute to reducing deaths and long-term

damage from stroke.

Symptoms include:

A sudden blockage of blood flow to an area of the brain, or bleeding, will produce symptoms of stroke. Symptoms may seem to improve, but you should still consider it as a stroke.

First aid providers can use stroke assessment systems such as FAST for individuals with suspected acute stroke. FAST is an easy way for remembering the signs of stroke.

• Facial weakness – can the person smile? Has their mouth or eye drooped?

• Arm weakness – can the person raise both arms?

• Speech difficulty – can the person speak clearly and understand what you say?

• Time to act fast – seek medical attention IMMEDIATELY. Call an ambulance by dialling 000.

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Other common symptoms of strokes include:

• numbness of the face, arm or leg on either or both sides of the body • difficulty swallowing • dizziness, loss of balance or an unexplained fall • loss of vision, sudden blurred or decreased vision in one or both eyes • headache, usually severe and of abrupt onset or unexplained change in the

pattern of headaches • drowsiness • confusion • reduced level of consciousness

Other conditions may also show the same symptoms of stroke, such as epilepsy,

migraine or diabetes with low blood sugar. If you are trained to check a blood sugar

level, it can improve the accuracy of stroke diagnosis when you use it in conjunction with

a stroke assessment tool.

When there is doubt over diagnosis, manage the casualty as having a stroke until proven otherwise.

A casualty with stroke symptoms will need to be transported by a medical team because of ongoing treatment which is necessary to manage the stroke. Paramedics can also notify the receiving hospital, reducing time to the start of treatment.

First aid treatment

• Regardless of how briefly symptoms appear, call an ambulance if any signs of stroke occur.

• Do not allow the consumption of food or drink.

• Administer oxygen if available and trained to do so (ANCOR Guideline 10.4). If a

pulse oximeter is available, provide oxygen only to casualties with oxygen saturation

of less than 94%.

• Reassure the casualty.

• If the casualty is unconscious but breathing, place them in the recovery position

• If the casualty is unresponsive and not breathing normally, start resuscitation by following the DRSABCD steps.

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2.3 Ensure casualty feels safe, secure and supported

As the person, responsible for providing first aid, you need to be aware of the value of non-physical care to the casualty and bystanders.

Any event that requires first aid causes stress in the casualty as well as those who are

unable to provide the necessary care, whether they are bystanders or one who is mildly

injured but unable to assist. Be aware of the stress on yourself as well – (we look at this

in more detail in Topic 4 of this guide).

2.3.1 Reassurance

The psychological value of reassurance is as important in first aid as the treatment that you give. It is important to comfort and reassure the casualty, as in some cases, all the casualty

needs are emotional support and reassurance.

A calm approach by the first aider and keeping the casualty informed of what is happening will also assist in the reassurance process not only for the casualty but bystanders as well.

It is important to consider all the people who have aided in the care of a casually as they too, may need reassurance and comfort.

Following an incident, take the time to recognise the contribution which was made by everyone and highlight the fact that it is a team effort.

2.3.2 Cultural Awareness

Cultural awareness is when you understand the impact your behaviour can have on the care

provided to others. It is important to have an awareness of cultural values, and you need to ensure that you

address any differences when approaching a casualty. For example, it is disrespectful for

a male to touch a female in some cultures, so you need to ask their permission to examine

them or provide treatment.

If they cannot give you their consent, try and find out about give you the consent. If nobody else is available, saving the person's life takes priority, but do so with sensitivity to their culture, for instance, don't remove clothing without providing alternative covering.

Always treat the casualty with respect and observe their rights not to be touched or handled. Be empathetic, unbiased and non-judgemental. Don't allow your beliefs and values interfere

with saving a life – discrimination in all its forms is illegal.

2.3.3 Children, the elderly, and the disabled

When assisting children, the elderly or disabled the following considerations will need to be factored into how you manage the emergency:

Children: A child will be frightened, especially if the first aider is a stranger. Ask the parent/relative/friend to calm the child and direct your questions to that person (if

possible).

Distract them by giving them something to do, such as holding a dressing or

stethoscope (but no sharp objects). Ask permission to remove clothing if they are a casualty, especially if they're of school-going age and aware of their modesty.

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Elderly/disabled: Be aware of their difficulty in moving (elderly need assistance) or disabilities that need assistance (e.g. wheel-chair bound, visually impaired).

The elderly may have fragile bones and thin skin, so be gentle when you need to handle them.

Support them when you need to position them and make sure they’re comfortable wherever you position them.

When you apply CPR on an elderly person, remember that you can easily break a

rib or sternum. CPR could also cause trauma such as spinal, liver and spleen

injuries, damage to airways, cause internal bleeding, or heart contusions (ruptured or

bruised capillaries).

Check for medical emergency bracelets or necklaces for “Do Not Revive”.

2.3.4 Do Not Revive/Resuscitate (DNR)

The ARC gives clear directives in their Guideline 10.5: Legal and Ethical Issues Related to Resuscitation, specifically as it pertains to first aid:

‘Do Not Attempt Resuscitation’ Orders

In out-of-hospital circumstances, emergency services are often activated for

patients in cardiac arrest who are chronically ill or have a terminal illness.

Responders need to establish there is an advanced care directive in place if a

decision maker is available.

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2.4 Obtaining consent from a casualty, caregiver,

medical practitioners and emergency services

The ARC’s Guideline, 10.5: Legal and Ethical Issues Related to Resuscitation, is clear about the issues governing consent for treatment given by medical professionals and first aiders.

2.4.1 Consent for Treatment

Before treating a casualty, a first aider must obtain their consent. Failure to obtain consent

potentially constitutes "medical trespass" (assault), and the casualty could recover

damages without the requirement of proof of injury, causation or negligence. If the casualty

has impaired decision-making capacity, obtain the consent from a substitute decision-maker

whenever possible, particularly in the case of an infant or child.

The parents or guardians of minors have the overwhelming right of autonomy and self-determination unless they are deemed as incompetent.

A person is considered to have impaired decision-making capacity (incompetent) if they are

not capable of understanding, retaining, using or communicating any information relevant

to making a healthcare decision.

Adults are assumed to be competent unless they have impaired decision-making capacity

while children are deemed to have impaired decision-making ability until they are 18 years

of age. However, most states permit younger persons to make decisions if they can

understand the issues involved.

In the case of infants and other children who are not capable of understanding the issues,

refusal to receive treatment can be difficult to interpret. In general, the parent/guardian

should decide whether the advantages outweigh the burden of any distress caused by

treatment. In the absence of a parent/guardian, responders should regard children as having

impaired decision-making capacity.

2.4.2 Treatment without Consent

Although treatment requires consent, you should not deprive an injured or ill person of treatment merely because they lack decision-making capacity.

The key legal factors that determine whether treatment can be given without consent are:

• whether the casualty does or doesn’t have decision-making capacity • whether an advance care directive exists • the degree of urgency of the situation and • whether a substitute decision-maker is present, willing and able to consent.

If the casualty is unable to give consent and no substitute decision maker is present, the

legal requirement to obtain consent before assistance or treatment is waived under Common

Law and Statute Law.

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2.5 Making the casualty as comfortable as possible

As a first aid provider, you will need some resources if you have to perform first aid on your own and provide treatment. You cannot transport the contents of an ambulance, but you can carry with you a selection of items that you can use in most emergencies.

The greatest tool is your knowledge and training – if you are in a situation where you don’t

have access to your equipment, you will be able to use available resources as a substitute.

For example, you can use a tree branch as a temporary splint or roll up a jumper to make a

pillow.

2.5.1 First aid kit

Healthdirect Australia provides the following checklist for the contents which should be

included in a first aid kit. Your first aid kit can also be customised, depending on the activities

you are involved in or specific needs to meet your workplace.

Some of the common items which should be included in a basic first aid kit are:

First Aid Items

crepe bandages of varying widths disposable gloves

hypoallergenic (skin) tape stainless steel pointed splinter

forceps (tweezers)

triangular bandages shock (thermal) blanket

adhesive dressing strips (such as safety pins

band aids) in different sizes

gauze swabs notepad and permanent marker

combine dressing pads (10cm x sterile saline tubes/sachets

10cm)

non-stick dressing pads (7.5cm x disposable resuscitation face shield

10cm)

sterile eye pad antiseptic skin swabs

alcohol swabs stop itch cream

stainless steel scissors (sharp/blunt) first aid booklet

12.5cm

Once you have assembled a basic first aid kit, you can customise it according to its intended use. For example, if it is:

• for use at home, add extra items according to the number of people in your home

and their age, such as thick crepe bandages if you have older children who play a

sport or for use as a pressure immobilisation bandage

• for the car or caravan, add a highly reflective (day/night) safety triangle and vest as you may be near a road and traffic

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• for camping, add thick crepe bandages, instant cold packs, disposable poncho, plastic bags, whistle, compass, torch and glow stick

• For use on a boat, add a disposable poncho, plastic bags, whistle and glow stick. If you are boating in waters where marine stingers are present, include vinegar to

pour over potential stings

• for babies, add extra items such as a digital thermometer, basic pain reliever medications (such as paracetamol or ibuprofen) and plastic syringes for

accurate dosing

• for known medical conditions, add extra items, such as medicines and/or equipment you normally use to manage the condition.

Note: Workplace first aid kits would have items unique to the workplace conditions and risk assessment outcomes. When you have collected all the articles for your first aid kit, you will need a bag or container to store them safely. The storage container you choose does not have to be expensive or designed especially for first aid supplies, but it should be:

• large enough to contain all the contents

• labelled as a first aid kit

• made of material that protects the contents from dust, moisture and contamination.

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2.6 Operating first aid equipment according to manufacturer’s instructions

The most common piece of equipment that a first aider (and any untrained person) will use

to save a life is an Automated External Defibrillator (AED). The technology has advanced to

the point where it gives voice prompts when in its use so that any person who understands

simple English will be able to follow its instructions.

2.6.1 Background information on AEDs

An AED detects lethal heart rhythms which stop the heart from pumping efficiently and then allows a responder to deliver a measured shock to a revert these rhythms so that the heart

can pump effectively again.

The importance of defibrillation has been well established as part of overall resuscitation,

along with effective cardiopulmonary resuscitation (CPR). An Automated External

Defibrillator (AED) must only be used for persons who are unresponsive and not

breathing normally. CPR must be continued until the AED is turned on and pads are

attached. The responder should then follow the AED prompts.

The time to defibrillate is a key factor that influences survival. For every minute defibrillation

is delayed, there is approximately 10% reduction in survival if the casualty is in cardiac

arrest due to Ventricular Fibrillation (VF), CPR alone will not save a person. Hence, a

defibrillator should be applied to the person in need as soon as it becomes available so that

a shock can be delivered if necessary.

The development of AEDs has made defibrillation part of basic life support. AEDs can accurately identify the cardiac rhythm as “shockable” or “non-shockable”.

Australian First Aid Interesting facts about using an AED

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2.6.2 Who should use an AED?

The use of an AED should not be restricted to trained personnel. Allowing the use of an AED by individuals without prior formal training can be beneficial and may be lifesaving.

While it is recommended that training in the use of AEDs be provided, the voice will allow

an untrained person to use the equipment safely. Even minimal exposure or training in the

speed of use or the correct pad placement can increase the rate of successful first aid

treatment.

The use of an AED by trained first aiders is recommended as this will increase survival rates in those who have presented with cardiac arrest.

2.6.3 Public Access to AEDs

The implementation of AED programs in public settings should be based on how effective it will

be. Because population and program characteristics affect survival, when implementing an

AED program, community and program leaders should consider factors, such as

• Location • Development of a team with responsibility for monitoring and maintaining the devices • Training and retraining programs for those who are likely to use the AED • Coordination with the local Emergency Services, and • Identification of a group of paid or volunteer individuals who are committed to using

the AED on those who are in cardiac arrest. Deployment of home AEDs for high-risk persons who do not have an implantable cardioverter defibrillator (ICD) is safe and feasible, and may be considered on an individual basis, but has not been shown to change overall survival rates.

Use of AEDs in public settings (airports, casinos, sports facilities, etc.) where witnessed cardiac arrest is likely to can be useful if an effective response plan is in place. An AED can

and should be used on pregnant women who are in cardiac arrest.

2.6.4 Using the defibrillator

The AED will guide you through the entire process until help has arrived by providing you with both visual and voice prompts.

If you are using the AED on a child aged between 1 - 8 you will ensure that the AED has paediatric capabilities such as the correct voltage for children in this age range.

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You will also need paediatric pads which must be used when defibrillation on a child aged between 1 – 8 is conducted. Follow the visual and voice prompts of the AED and:

If you see someone collapses, immediately call 000 and get the paramedics

en route. If there are other people around, choose someone

specific and instruct them to call 000 and explain the situation.

This decreases confusion about who should do what and ensures

that the call is being placed.

If someone has collapsed, you should immediately determine whether

they are breathing. If the casualty is breathing, you know

that they have a pulse. If the casualty is not breathing, check the airway is clear

then begin CPR by giving 30 chest compressions at a depth of one-third (1/3) of

the chest thickness and then give two breaths.

3. Locate an AED If there is an AED nearby, ask a bystander to bring the AED to you

while you continue CPR. Apply the AED electrode pads to the

bare chest of the casualty and follow the prompts as instructed.

Uninterrupted CPR is an important factor in increasing the

recovery rate of cardiac arrest patients.

4. Turn on the Follow the visual and voice prompts of the AED

AED 5. Attach the First, ensure that the adhesive AED pads are attached to a cable, electrode pads to which is plugged into the AED machine. Then bare the casualty's the casualty's

chest including females and attach the adhesive AED pads in the

appropriate locations. The AED should include a diagram (typically on the

adhesive pads themselves) indicating where each pad placed on the patient’s

chest. It is important not to touch the casualty while the AED is "analysing" as

it may detect your heart rhythm.

Always follow the instructions of the AED. NOTE: CPR should not be interrupted while the adhesive electrode pads are being

applied.

Source: Australian Defibrillators

How to perform CPR & use an iPad AED (defibrillator)

Click here for more

bare chest

(Expose the

patient's bare

chest, male or female)

1. Call 000

2. Check the casualty's breathing and

airway

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2.7 Monitoring the casualty’s condition

Once you have provided the appropriate first aid treatment to a casualty, you need to monitor their condition to ensure their condition remains stable.

2.7.1 Monitor and respond by first aid principles

Unconscious casualties take precedence over those who can communicate their condition; it usually means they are responsive and that their condition is stable. However, you still

need to monitor their vital signs to ensure they aren’t deteriorating.

The four vital signs that require monitoring every five minutes are:

Vital Sign

Pulse

Breathing

Monitoring required • Adult 60-80 per minute • Children (1-8 years) 70-140 per minute

• Infants (under one year) 90-160 per minute

Needs attention when the pulse is: • Irregular

• Weak

• Too fast/slow

• Adult 12-18 per minute

• Child (1-8 years) 16-30 per minute

• Infants (under one year) 25-50 per minute

Needs attention when breathing is: • Gasping • Noisy • Too slow/fast • Painful

Consciousness Use the acronym AVPU to determine

the level of consciousness: A – Alert and responds to stimulus

and voice.

V – Responds only to voice, no response to a stimulus.

P – Responds only to a small amount of pain, e.g. pin prick on

hand U – Unresponsive to all stimuli, unconscious

Skin colour/ • Skin colour is abnormal, e.g. blue or dark patches, grey skin overall,

redness, abnormal temperature, sweating. condition

• Check colour around the lips and under fingernails.

• Check capillary refill – should be less than 2 seconds.

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Section 3: Communicate details of the incident

Keeping accurate records of an incident has more than one face including:

• a record your assessments of the scene and casualties so that you can convey the information to medical responders and maintain workplace emergency documentation

• communicate certain details to medical staff, paramedics, carers and family

Confidentiality of those records should be a priority in all circumstances, and this topic details the procedures for keeping records safe.

The topics that will be covered in this section include:

3.1 Convey incident details to emergency services

3.2 Reporting details of an incident to your supervisor

3.3 Completing relevant workplace documentation

3.4 Maintaining confidentiality of records and information

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3.1 Convey incident details to emergency services

As the first person on the scene of an incident that requires first aid assistance, your

accurate and detailed assessment of the scene will help the operator taking your call relay

your message to the most appropriate responders.

When you first arrive on the scene, assess and make notes as accurately as you can. If

possible, take photos and video with your cell phone, but not if it will drain your battery –

you need it to phone emergency services.

3.1.1 Conduct an accurate assessment

Using the triage principles (Topic 2.2.1) as the basis for your assessment, note the following information to be given to the emergency service operator and responder:

Information for emergency service operator and responder

Quick Check if there is any danger to yourself, the casualty and assessment bystanders.

Check hazards and calculate risk posed by hazard.

Remove casualty from danger OR remove/eliminate danger.

NOTE: Electricity is the single biggest risk when providing first aid – make sure there aren’t any live electrical cables or danger of being electrocuted.

Identify the Check consciousness. nature of illness

Determine triage level or injury

Communicate Provide an accurate description of your location; if you have GPS information location give the coordinates.

Give the street address, closest cross street, landmarks.

Arrange to meet the emergency services at a particular point.

If you are travelling and saw an incident, mention the highway/main road, your direction of travel, what you remember about the location of the incident, and the last exit or town you went through.

The information you gather from your initial assessment will help the emergency personnel provide the best response.

For example, if the casualty fell a deep ravine and could not be reached easily, the

emergency personnel will have specialised equipment to reach the casualty and place air transport on notice.

Also, if you report that the casualty is trapped underneath a car and you can smell petrol,

the operator will notify the fire brigade who will dispatch the appropriate emergency

response team.

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3.2 Reporting details of an incident to your supervisor

If you are in a workplace situation, it is important that you follow your organisation's WHS procedures when reporting any emergency incidents.

3.2.1 When to report a workplace incident

Part of the reporting procedures you should follow in the event of an emergency, injury or illness will be reporting the incident to your supervisor as soon as possible.

If your organisation doesn’t have such procedures, you still must report the incident to the correct authorities.

Safe Work Australia Incident Notification Information Sheet

Click here for more

Under the Workplace Health and Safety Act must ensure that:

• a “notifiable incident” be reported to the regulator immediately after becoming aware it has happened

• if the regulator asks, written notification within 48 hours of the request, and

• the incident site to be preserved until an inspector arrives or directs otherwise

(subject to some exceptions). Failing to report a “notifiable incident” is an offence and penalties apply.

A “notifiable incident” is the death of a person, a “serious injury or illness”, or a “dangerous

incident” arising out of the conduct of a business or undertaking at a workplace.

“Notifiable incidents” may relate to any person, whether an employee, contractor or member of the public.

The WHS Act also specifies the duties of the PCBU and its employees as follows:

Workplace duties relating to first aid

PCBU’s, such as company directors, have a duty to exercise due diligence to

ensure that the business or undertaking complies with the WHS

Act and Regulations. This includes taking reasonable steps to ensure that the business or undertaking has and

uses appropriate resources and processes to eliminate or minimise risks to health and safety.

Workers have a duty to take reasonable care for

their health and safety and must not adversely

affect the health and safety of other persons.

Workers must comply with any reasonable

instruction and cooperate with any reasonable

policy or procedure relating to health and safety at

the workplace, such as procedures for first aid and

for reporting injuries and illnesses.

Source: Safe Work Australia

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3.3 Completing relevant workplace documentation

During your induction, your supervisor should have given you the organisation’s

compendium of policies and procedures, including the incident reporting form. Make sure the

form is easily accessible should you need to report an incident.

3.3.1 Reporting details of an incident

As a first aid officer in the workplace, you are responsible for keeping records of all

incidents, whether they are notifiable or not. This protects the company from fraudulent claims and safeguards you should a worker sue you for negligence.

A typical incident report will have the following information:

Inclusions in a typical incident report

Dates and times When did the incident occur?

Was the worker on official duty?

Work status Did the injured/ill person stop work (dates)?

Did the person return:

• To standard/previous work

• To alternative work

Was the person:

• Treated by a doctor

• Managed by a first aid officer on site

• Hospitalised

Did the worker claim compensation (details)?

Did the worker need rehabilitation?

Comments Observations on the incident, what caused it, what tools were used, environmental factors, the health status of the casualty, whether

they were intoxicated/on drugs, etc.

Risk assessment Likelihood of incident occurring again.

Severity of outcome (on a predetermined scale).

Measures to prevent recurrence (training, change in process, etc.)

Dates and times the measures were implemented.

Report details Name and signature of persons dealing with the case (first aid officer, supervisor, witnesses, etc.)

Dates and times of signature.

Contact details of above persons.

Details of WHS review, if applicable (meetings, officers, representatives, etc.)

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3.3.2 Reporting details of incidents involving babies and children to parents and caregivers

Any incident that involves a child or infant is traumatic, and if the child is in the care of

somebody other than the parents/guardians/caregivers, the incident must be reported

to them and the authorities.

Verbally reporting minor incidents* (cuts, abrasions) to the parents/guardians/caregivers is adequate, but for serious incidents, the law stipulates that you need to report the details to the authorities as well.

If you are operating an education and care service, you must adhere to the entire Education and Care Services National Law Act. The following section deals specifically with reporting

an incident to the authorities.

Education and Care Services National Law Act 2010, No. 69 of 2010

174 Offence to fail to notify certain information to Regulatory Authority

(2) An approved provider must notify the Regulatory Authority of the following information

about an education and care service which is operated by the approved provider—

(a) any serious incident at the approved education and care service;

(5) In this section - serious incident means an incident or class of incidents prescribed by the national regulations as a serious incident.

Source: Victorian Legislation and Parliamentary Documents

For more information on the legislations and regulations which must be followed if providing care to infants and children go to the following websites:

State or Territory Legislation Application Act

Victoria Education and Training Victoria

New South Wales Children (Education and Care Services

National Law Application) Act 2010

Australian Capital Education and Care Services National Law Territory

Education and Care (ACT) Act 2011

Northern Territory Services National Law

Education and Care Services (National Act 2010

Uniform Legislation) ACT 2011

South Australia Education and Early Childhood Services

(Registration and Standards) Act 2011

Tasmania Education and Care Services National Law

(Application) Act 2011

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State or Territory Legislation Application Act

Queensland Education and Care Services National Law (Queensland) Act 2011

Western Australia Education and Care Services National Law

(WA) Act 2012

From: Australian Children’s Education and Care Quality Authority

3.3.3 Reporting serious incidents to the regulatory authority

Each industry has its procedure to report serious incidents, but the WHS Act governs the law that requires workplace incident reporting.

If a notifiable incident occurs, the WHS Act specifies that:

• immediate notification of a “notifiable incident” to the regulator, after becoming aware of it

• if the regulator asks—written notification with 48 hours of the request, and • preservation of the incident site until an inspector arrives or directs otherwise.

Notifiable VS Non-Notifiable Incidents: What’s the Difference?

Click here for more

For more information on notifiable incidents, please contact your work health and safety regulator.

If you need to report a workplace incident contact the regulator in your jurisdiction (see table below).

Jurisdiction Regulator Telephone Website

New South Wales Safe work NSW 13 10 50 safework.nsw.gov.au

Victoria Victorian WorkCover 1800 136 089 worksafe.vic.gov.au Authority

Queensland Workplace Health and 1300 362 128 worksafe.qld.gov.au Safety Queensland

South Australia SafeWork SA 1300 365 255 safework.sa.gov.au

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Western Australia WorkSafe WA 1300 307 877 worksafe.wa.gov.au

Australian Capital

WorkSafe ACT 02 6207 3000 worksafety.act.gov.au

Territory

Tasmania WorkSafe TAS 1300 366 322 worksafe.tas.gov.au

(Within Tasmania)

03 6233 7657 (External)

Northern Territory NT WorkSafe 1800 019 115 worksafe.nt.gov.au

Commonwealth Comcare 1300 366 979 comcare.gov.au

From: Safe Work Australia: Workplace Incidents Reporting

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3.4 Maintaining confidentiality of records and information

A first aid provider is in a position of trust: the casualty trusts you to save their life or at least alleviate their suffering.

That measure of confidence extends to details about the incident – their health status, the

care you gave them, medication, and recuperation. They trust you to keep their records safe

and confidential. In addition to that trust, as a practitioner in the medical profession, you are

bound by law to keep records private and confidential.

3.4.1 The Privacy Act 1988

The Australian Privacy Act 1988 regulates the handling of personal information about

individuals. Personal information is information or an opinion about an identified

individual, or an individual who is reasonably identifiable.

The Privacy Act includes thirteen Australian Privacy Principles (APPs). The APPs set out standards, rights and obligations for the handling, holding, use, accessing and correction of personal information (including sensitive information).

With reference to “health service providers”, the Act describes the responsibilities in keeping records safe and confidential:

As stated in the Privacy Act 1988, a "health service" includes any activity that involves:

• assessing, maintaining or improving a person's physical or psychological health

• where a person’s health cannot be maintained or improved – managing the person’s physical or psychological health

• diagnosing or treating a person's illness, disability or injury • recording a person’s physical or psychological health for the purposes of

assessing, maintaining, improving or managing the person’s health • dispensing a prescription drug or medicinal preparation by a pharmacist.

This includes activities that take place during the provision of aged care, palliative care or care for a person with a disability.

Examples of organisations providing a health service include:

• traditional health service providers, such as private hospitals, day surgeries,

medical practitioners, pharmacists and allied health professionals • complementary therapists, such as naturopaths and chiropractors • gyms and weight loss clinics • child care centres and private schools.

The Privacy Act regulates how these organisations collect and handle personal

information, including health information. It also includes provisions that allow an

individual to access information held about them. The Office of the Australian Information

Commissioner (OAIC) also regulates the handling of health information held in an

individual's My Health Record, and the handling of healthcare identifiers.

The OAIC has developed privacy fact sheets, and business resources to help individuals and organisations providing a health service understand their rights and responsibilities. Further

information about health and medical research is also available on the FAQS for individuals — Health and FAQs for health service providers.

Source: Office of the Australian Information Commissioner

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3.4.2 Organisational policies and procedures

Australian businesses are required to keep records prescribed by federal law. Apart from the usual business requirements, WHS legislation specifies how you should deal with medical information and privacy as follows:

Health and medical information are a central concern of the Commonwealth

privacy law that covers Australian businesses. The Privacy Act 1988 aims to

protect the privacy of individuals and to enable people to have their complaint

investigated if they believe the privacy of their personal information has been

compromised. Under the Act, a set of privacy principles known as the

Australian Privacy Principles (APPs) regulates the handling of personal

information, including medical information.

Sensitive information

Information or an opinion about an individual’s health falls into the category of

‘sensitive information’, together with other matters including the person’s

genetic or biometric information, racial or ethnic origin, sexual preferences and

political or religious opinions, beliefs or affiliations. Health and medical

information collected by employers may consist of the results of pre-

employment medicals, periodic medicals to assess fitness for duty, health

monitoring for exposure to hazardous chemicals, workers’ compensation

claims and retirement medicals.

Sensitive information is given a higher level of protection than general

personal information of the type that employers often collect about their

employees, such as the content of their personnel files, referees’ reports

and similar material.

However, the handling of an individual's personal information,

including health information, by a private sector employer is exempt

from the Privacy Act if it is directly related to that person's employee

record or current or former employment relationship.

Source: Workplace OHS

Storing employee records

Apart from the legal requirements, personal information, especially relating to health,

should be kept confidential and in a way, that designated personnel can access them quickly. The two methods to maintain confidential records are generally:

• Paper-based – o Ensure proper policies and procedures are in place o Keep documents locked in a fireproof cabinet/room o Give access only to designated personnel o Maintain a paper document management system

• Electronic – o Investigate the advantages and disadvantages of electronic recordkeeping o Ensure proper policies and procedures are in place o Keep an electronic document management system

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Private first aid providers

Privacy and confidentiality are basic human rights, and we all have the essential need to keep our medical information private.

As a first aider, you need to keep all information of the incident private and confidential

(refer to Topic 3.1) and not speak to media, unauthorised people, and even family; ask

permission from the casualty to discuss the details. Not only is confidentiality good ethics,

but sharing information without permission is also illegal.

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Section 4: Evaluating the incident

First aid providers risk mental and physical stress due to ongoing traumatic incidents. The

adrenaline rush of saving a life is in stark contrast to losing a casualty whose life you saved only to have them pass away shortly after, or being unable to save a life at the scene.

It is easy to work through the impact of one event, but it becomes difficult the more incidents you attend to; you need emotional and mental support to ensure you don't become a

medical emergency yourself.

First aid isn’t just about the physical application of your skills and knowledge; first aid also means supporting those affected by a traumatic incident and such support also takes its toll

on you.

The topics that will be covered in this section include:

4.1 Evaluating the possible psychological impacts when providing first aid

4.2 Talking with children about their emotions and responses to events

4.3 Participating in a debriefing with your supervisor

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4.1 Evaluating the possible psychological impacts when providing first aid

Stress is defined as mental, physical, or emotional strain caused by ongoing negative

external events, activities, or another stimulus, which can be a chemical or biological agent, and environmental condition.

4.1.1 Recognising the possible impact on yourself and others following an emergency

The psychological impact of providing first aid has many physical consequences and if left untreated could mean that you might need first aid yourself.

Some of the more common signs and symptoms are provided in the table below:

Signs and symptoms

Inability to ward off colds and flu Irritable

Depression Eating disorders

Anger Swearing

Decreased memory Anxiety

Muscle aches Frequent/uncontrolled crying

Impatience Muscle cramps

Loss of sense of humour/don’t laugh Impatient

Change in general behaviour Too much alcohol

Poor judgement Unable to focus

There are also physical signs that you are suffering from stress, and if you are concerned, you should seek advice as soon as possible to avoid the issue from escalating.

Stress Symptoms, Signs, and Causes The harmful effects of stress and what you can do about it.

Click here for more

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Consequences of stress

Stress affects all parts of the body, and if you don't manage the effects, the body's defence

mechanisms break down so that you are no longer able to fight off diseases and illnesses

that you would normally be able to fight off, obesity or anorexia from changed eating habits,

heart problems, and diabetes.

Managing stress

To counteract the effects of stress:

1. Recognise that there is a problem 2. Discuss the problem 3. Implement stress-management techniques

a. Counselling or group therapy b. Improve diet and boost immune system c. Partake in relaxation techniques, such as yoga, tai chi, meditation d. Do exercise unrelated to your first aid environment, e.g. golf

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4.2 Talking with children about their emotions and responses to events

Children experience and express the effects of stress differently to that of adults, and the

stressors that are “normal” for adults become overwhelming for children. The reason being

that they have no point of reference to which they can compare the event. If the child

doesn’t deal with the emotional impact of the event, it could affect their brain development

and cause health problems.

4.2.1 Dealing with children’s emotions in an emergency

According to Kids Matter, a mental health promotion, prevention and early intervention

initiative set in primary schools and early childhood education and care (ECEC) services –

like preschools, kindergartens and day care centres, kids experience three types of

stress.

How kids experience stress

1. Positive stress response - is considered as a normal part of healthy

development, for example, going to school camp or starting at a new school.

When experienced in a supportive environment, it can provide important

opportunities to learn and practise healthy responses to life changes.

2. Tolerable stress response – activates the body’s alert systems to a greater degree because of more severe, longer-lasting stressors, for example, parental divorce, illness or injury, or bullying at school.

3. Toxic stress response – can occur when a child experiences robust and prolonged multiples stressful events without adequate adult support, for example, physical or emotional abuse, chronic neglect, parental mental illness, or exposure to violence. It can disrupt early brain development and lead to many health problems.

The good news is that the damaging effects of toxic stress can be prevented or

reversed if the child is placed in a supportive environment with caring adults as

early in life as possible. Children experiencing tolerable (and especially toxic) stress

may require the support from a mental health specialist who can provide ongoing

therapeutic support and counselling. Telephone and online counselling services like

Kids Helpline can also be helpful for children (and parents).

Source: Kids matter

The loss of a loved one or severe disability resulting from a traumatic event cause post-

traumatic stress disorder (PTSD) in children. An organisation called Women’s and Children’s

Health Network are committed to providing health and parenting information based on the

latest research and best practice by offering:

• support to parents in areas of parenting • health services for infants, children and young people

• support for families and children with additional needs • up-to-date health information for parents, children and young people.

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Their website outlines the support interventions for children with PTSD; although they focus on parents’ support, as the first aid provider, you need to step into that role to provide the best care for the child (where you can).

Kids Matter The signs, symptoms, and management of trauma in children

Click here for more

Armed with the appropriate information you are also able to support the parent/guardian so

that they can support the child further. The following information has been adapted from the

Women’s and Children’s Health Network and will be useful when dealing with how children

respond to events:

What you can do

• Let your children know you are there for them, keep them close and hug them

• Allow the child to talk when they feel ready

• Ask older children how they would like you to help or support them

• Talk to the child’s brothers and sisters about what is happening/has happened and listen to their feelings as well

• Sometimes reading stories about a child or animal in a similar situation can help children feel more in control

• Keep the child's normal routine going as much as possible, this provides a feeling of safety

• Protect children from adults who are insensitive or do not understand

• Be patient and don’t expect too much too soon

• Don't expect too much too soon.

• Remember to let the child's teacher or child care worker know what has happened so they can be ready to support your child.

It may be helpful to minimise the amount of extra stress your child must deal with, e.g. from television, newspapers.

Adapted from: Women and Children’s Health Network

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4.3 Participating in a debriefing session with your supervisor

Dealing effectively with an emergency can be quite detailed, so it is important to discuss the

event once you have completed your hand over to the appropriate emergency services. It is

important that debriefing sessions are completed as soon as possible so that any additional

support which may be needed can be provided.

Debriefing consists of two (2) major actions which involve:

• Discussing the incident and making sure you have the proper psychological support

• Working as part of a team it is important to debrief others who were witness to or were involved in in the incident

4.3.1 Critical Incident Stress Debriefing (CISD)

If you have had to manage a critical incident, it is important to manage this by conducting or participating in a Critical Incident Stress Debriefing (CISD).

The primary objectives of this type of debriefing are to:

• Mitigate or reduce the impact of the incident

• Provide facilitation of the standard recovery process. This includes restoring the

normal, healthy psychological functions, following a distressing and disturbing event

• Identify anyone who may benefit from additional support services and referral to

professional care if needed.

To complete a CISD debriefing, there are seven (7) phases, plus follow-up, consisting of:

Phase

1. Introduction

2. Facts

3. Thoughts

4. Reactions

5. Symptoms

6. Teaching

7. Re-entry

Follow-up

Process

In this phase, the team members introduce themselves and describe the process.

Only extremely brief overviews of the facts are requested.

The thought phase is a transition from the cognitive domain toward the affective domain.

The reaction phase is the heart of a Critical Incident Stress Debriefing.

Team members ask questions and listen carefully for common

symptoms associated with exposure to traumatic events.

The team conducting the Critical Incident Stress Debriefing

normalises the symptoms brought up by participants.

The participants may ask questions or make final statements.

The CISD is usually followed by refreshments to facilitate the beginning of monitoring services.

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Critical Incident Stress Debriefing (CISD) The CISD process

Click here for more

4.3.2 Organisational debriefing process

It is important that you follow your organisation’s debriefing procedures to ensure you

applied first aid according to legal and organisational guidelines. Ensure you have all the

correct documents and that you filled them in according to the information at your disposal.

When you are preparing for the debriefing with your supervisor, ask yourself the following questions:

• Did you provide first aid within you current training and mandate?

• Did the organisation provide appropriate training for the type of incident you had to attend, and did you complete that training?

• Did you follow the organisation’s procedures and action plans? If not, why not? (Discuss possible improvements from lessons learned.)

• Was there a problem with communication?

• Was there a problem with communication technology?

• Was all the required first aid equipment available?

Private capacity

If you provided first aid in your personal capacity, talk to the medical responders

whenever it is convenient so that you can identify areas for improvement.

You could also follow up with medical staff if the person you rescued had to be hospitalised. Take any constructive criticism as an opportunity to learn from what you did wrong as well as acknowledge the praise for what you did right.

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Acknowledgments

Australian https://resus.org.au/guidelines/

Resuscitation Council https://resus.org.au/glossary/

Safe Work Australia https://www.safeworkaustralia.gov.au/doc/model-code-practice-first-aid-workplace

The Department of http://www.health.gov.au/internet/publications/publishing.nsf/Content/cardio-pubs-

Health review~cardio-pubs-review-08-currentprograms~cardio-pubs-review-08-

currentprograms-1-pb

Australian Children’s http://files.acecqa.gov.au/files/National-Quality-Framework-Resources-Kit/NQF-

Education & Care Resource-02-Guide-to-ECS-Law-Regs.pdf

Quality Authority

Collins Dictionary https://www.collinsdictionary.com/

Australian Red Cross http://redcross.e3learni ng.com.au/content/sfademo/topic2/page2/

Attorney-General’s https://www.triplezero. gov.au/pages/usingotheremergencynumbers.asp x

Department Epilepsy Society https://www.youtube.com/watch?v=dv3agW-DZ5I

ACT Emergency http://cdn.esa.act.gov.au

Services Agency

Sydney Uni Sport and https://www.susf.com.au/files/Chapter_2_Approach_to_the_Incident.pdf

Fitness

Adapted from: https://s-media-cache-

BayCare’s Helpful Tips ak0.pinimg.com/236x/c3/7f/86/c37f86573a6895c600946880d8a26110.jpg

on ER vs. Urgent Care

Life Saving Solutions https://www.youtube.com/watch?v=ItI6KQknee8

Training Aid Australia https://www.youtube.com/watch?v=BjKb_hNNeTM

UNMC HEROES https://www.youtube.com/watch?v=9QHDs10e-G0

Australian First Aid http://www.australianfirstaid.com.au/defibrillators/facts-you-should-know/

Australian (http://www.aeds.com.au/use-an-aed.html)

Defibrillators U Tube https://www.youtube.com/watch?v=7lhSd5ONbNY

Victorian Legislation http://www.legislation.vic.gov.au

and Parliamentary

Documents

Office of the Australian https://www.oaic.gov.au/privacy-law/privacy-act/health-and-medical-

Information research#health-service-providers

Commissioner

Kids Matter https://www.helpguide.org/articles/stress/stress-symptoms-causes-and-effects.htm

Women and Children’s http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=141&id=160

Health Network 8

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